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He Y, Liber A, Driezen P, Thompson ME, Levy DT, Fong GT, Cummings KM, Shang C. How do users compare the costs between nicotine vaping products and cigarettes? Findings from the 2016-2020 International Tobacco Control United States surveys. Addiction 2024; 119:885-897. [PMID: 38186201 PMCID: PMC11009094 DOI: 10.1111/add.16425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 11/23/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND AND AIMS Nicotine vaping products (NVPs) can potentially help adult tobacco users quit smoking. This study evaluated how adult consumers compare the costs between NVPs and cigarettes. METHOD We used data from the US arm of the 2016-2020 International Tobacco Control Four Country Smoking and Vaping (ITC 4CV) surveys to perform a multinomial logit model with two-way fixed effects to measure how perceived cost comparisons are associated with NVP and cigarette taxes, use patterns, NVP device types and individual sociodemographic factors. RESULTS Higher cigarette taxes are associated with a greater likelihood of perceiving NVPs and cigarettes as costing the same for the overall population and among people who exclusively smoke, and a lower likelihood of perceiving NVPs as more expensive among people who exclusively vape, compared with lower cigarette taxes. Pre-filled cartridge and tank users are more likely to perceive NVPs as less expensive than cigarettes, compared with people who use other types of NVPs. The associations between taxes and perceived cost comparison were more pronounced among males, younger and low-income populations. CONCLUSIONS Higher cigarette taxes are associated with perceived financial incentives for nicotine vaping products (NVPs) over cigarettes, whereas NVP taxes are not associated with perceived cost comparison between NVPs and cigarettes.
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Affiliation(s)
- Yanyun He
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Alex Liber
- Department of Oncology, School of Medicine, Georgetown University, Washington, DC, USA
| | - Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Mary E. Thompson
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada
| | - David T. Levy
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Geoffrey T. Fong
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - K. Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Ce Shang
- Department of Internal Medicine, Medical Oncology Division, The Ohio State University, Columbus, OH, USA
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Sharma E, Lauten K, Zebrak KA, Edwards KC, VanEtten S, Benson AF, Delnevo CD, Marshall D, Kimmel HL, Taylor KA, Bansal-Travers M, Hyland A, Cummings KM. Respiratory symptoms and outcomes among cigar smokers: findings from the Population Assessment of Tobacco and Health (PATH) study waves 2-5 (2014-2019). Respir Res 2024; 25:185. [PMID: 38678212 PMCID: PMC11055341 DOI: 10.1186/s12931-024-02818-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/19/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND The mechanisms by which cigarette smoking increases the risk of respiratory disease have been studied. However, less is known about risks of respiratory symptoms and outcomes associated with smoking cigars, and risks by cigar types have not been previously explored. The aim of this study was to examine associations between cigar use, including traditional cigars, cigarillos, filtered cigars, and dual cigar and cigarette use, and functionally important respiratory symptoms (FIRS), lifetime asthma diagnosis, uncontrolled asthma, and new cases of FIRS. METHODS Data from Waves 2-5 (2014-19) of the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative longitudinal study, were analyzed in two ways. For cross-sectional analysis, the analytic sample included adults 18 and older at each wave, resulting in 44,040 observations. Separately, longitudinal analyses were assessed among adults 18 and older at Wave 2, resulting in 7,930 individuals. Both analyses excluded adults with chronic obstructive pulmonary disease (COPD) or non-asthma respiratory disease. RESULTS Current established cigarillo smokers had higher odds of having FIRS (Adjusted odds ratio (AOR): 1.72; 95% CI: 1.08, 2.74) compared to never smokers of cigarillos and cigarettes, after adjusting for covariates. Current established filtered cigar smokers had higher odds of asthma diagnosis (AOR: 1.35; 95% CI: 1.10, 1.66) while current established dual smokers of filtered cigars and cigarettes had higher odds of uncontrolled asthma (AOR: 5.13; 95% CI: 1.75, 15.02) compared to never smokers of filtered cigars or cigarettes. Both current established cigar smokers and current established dual smokers of cigarettes and cigars had higher odds of new FIRS compared to never cigar or cigarette smokers (AORs: 1.62; 95% CI: 1.02, 2.60 for exclusive cigars and 2.55; 95% CI 1.57, 4.14 for dual smokers). CONCLUSIONS This study provides evidence that cigar smokers or dual smokers of cigars and cigarettes have greater odds of FIRS, asthma, and uncontrolled asthma and that new incidence of FIRS is higher among any cigar smokers compared to never cigar or cigarette smokers. Understanding health impacts associated with cigar use provides information for supporting policy development, as well as for designing clinical interventions focused on smoking cessation for cigars.
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Grants
- Contract Nos. HHSN271201100027C and HHSN271201600001C National Institute on Drug Abuse, National Institutes of Health (NIH NIDA), and the Center for Tobacco Products, Food and Drug Administration (FDA CTP)
- Contract Nos. HHSN271201100027C and HHSN271201600001C National Institute on Drug Abuse, National Institutes of Health (NIH NIDA), and the Center for Tobacco Products, Food and Drug Administration (FDA CTP)
- Contract Nos. HHSN271201100027C and HHSN271201600001C National Institute on Drug Abuse, National Institutes of Health (NIH NIDA), and the Center for Tobacco Products, Food and Drug Administration (FDA CTP)
- Contract Nos. HHSN271201100027C and HHSN271201600001C National Institute on Drug Abuse, National Institutes of Health (NIH NIDA), and the Center for Tobacco Products, Food and Drug Administration (FDA CTP)
- Contract Nos. HHSN271201100027C and HHSN271201600001C National Institute on Drug Abuse, National Institutes of Health (NIH NIDA), and the Center for Tobacco Products, Food and Drug Administration (FDA CTP)
- Contract Nos. HHSN271201100027C and HHSN271201600001C National Institute on Drug Abuse, National Institutes of Health (NIH NIDA), and the Center for Tobacco Products, Food and Drug Administration (FDA CTP)
- Contract Nos. HHSN271201100027C and HHSN271201600001C National Institute on Drug Abuse, National Institutes of Health (NIH NIDA), and the Center for Tobacco Products, Food and Drug Administration (FDA CTP)
- Contract Nos. HHSN271201100027C and HHSN271201600001C National Institute on Drug Abuse, National Institutes of Health (NIH NIDA), and the Center for Tobacco Products, Food and Drug Administration (FDA CTP)
- Contract Nos. HHSN271201100027C and HHSN271201600001C National Institute on Drug Abuse, National Institutes of Health (NIH NIDA), and the Center for Tobacco Products, Food and Drug Administration (FDA CTP)
- Contract Nos. HHSN271201100027C and HHSN271201600001C National Institute on Drug Abuse, National Institutes of Health (NIH NIDA), and the Center for Tobacco Products, Food and Drug Administration (FDA CTP)
- Contract Nos. HHSN271201100027C and HHSN271201600001C National Institute on Drug Abuse, National Institutes of Health (NIH NIDA), and the Center for Tobacco Products, Food and Drug Administration (FDA CTP)
- Contract Nos. HHSN271201100027C and HHSN271201600001C National Institute on Drug Abuse, National Institutes of Health (NIH NIDA), and the Center for Tobacco Products, Food and Drug Administration (FDA CTP)
- Contract Nos. HHSN271201100027C and HHSN271201600001C National Institute on Drug Abuse, National Institutes of Health (NIH NIDA), and the Center for Tobacco Products, Food and Drug Administration (FDA CTP)
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Affiliation(s)
- Eva Sharma
- Westat, 1600 Research Blvd., Rockville, MD, 20850, USA.
| | | | | | | | - Samantha VanEtten
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD, USA
| | - Adam F Benson
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD, USA
| | - Cristine D Delnevo
- Rutgers Institute for Nicotine & Tobacco Studies, Rutgers Biomedical and Health Sciences, Rutgers University, New Brunswick, NJ, USA
| | - Daniela Marshall
- National Institute On Drug Abuse, National Institutes of Health, Bethesda, MD, USA
- Axle Informatics, Rockville, MD, USA
| | - Heather L Kimmel
- National Institute On Drug Abuse, National Institutes of Health, Bethesda, MD, USA
| | | | - Maansi Bansal-Travers
- Department of Health Behavior, Division of Cancer Prevention & Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Andrew Hyland
- Department of Health Behavior, Division of Cancer Prevention & Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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3
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Driezen P, Gravely S, Kasza KA, Thompson ME, Cummings KM, Hyland A, Fong GT. Prevalence of menthol cigarette use among adults who smoke from the United States by census division and demographic subgroup, 2002-2020: findings from the International Tobacco Control (ITC) project. Popul Health Metr 2024; 22:6. [PMID: 38594706 PMCID: PMC11005135 DOI: 10.1186/s12963-024-00326-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/31/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Targeted marketing of menthol cigarettes in the US influences disparities in the prevalence of menthol smoking. There has been no analysis of sub-national data documenting differences in use across demographic subgroups. This study estimated trends in the prevalence of menthol use among adults who smoke in the nine US census divisions by sex, age, and race/ethnicity from 2002 to 2020. METHODS Data from 12 waves of the US ITC Survey were used to estimate the prevalence of menthol cigarette use across census divisions and demographic subgroups using multilevel regression and post-stratification (n = 12,020). Multilevel logistic regression was used to predict the prevalence of menthol cigarette use in 72 cross-classified groups of adults who smoke defined by sex, age, race/ethnicity, and socioeconomic status; division-level effects were fit with a random intercept. Predicted prevalence was weighted by the total number of adults who smoke in each cross-classified group and aggregated to divisions within demographic subgroup. Estimates were validated against the Tobacco Use Supplement to the Current Population Survey (TUS-CPS). RESULTS Overall modeled prevalence of menthol cigarette use was similar to TUS-CPS estimates. Prevalence among adults who smoke increased in each division from 2002 to 2020. By 2020, prevalence was highest in the Middle (46.3%) and South Atlantic (42.7%) and lowest in the Pacific (25.9%) and Mountain (24.2%) divisions. Prevalence was higher among adults aged 18-29 (vs. 50+) and females (vs. males). Prevalence among non-Hispanic Black people exceeded 80% in the Middle Atlantic, East North Central, West North Central, and South Atlantic in all years and varied most among Hispanic people in 2020 (Pacific: 26.5%, New England: 55.1%). CONCLUSIONS Significant geographic variation in the prevalence of menthol cigarette use among adults who smoke suggests the proposed US Food and Drug Administration (FDA) menthol cigarette ban will exert differential public health benefits and challenges across geographic and demographic subgroups.
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Affiliation(s)
- Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada.
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada.
| | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
| | - Karin A Kasza
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Mary E Thompson
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada
| | - K Michael Cummings
- Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
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4
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He Y, Fong GT, Cummings KM, Hyland A, Shang C. The association between excise taxes and smoking and vaping transitions-Findings from the 2016-2020 ITC United States surveys. Int J Drug Policy 2024; 126:104372. [PMID: 38422713 DOI: 10.1016/j.drugpo.2024.104372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 02/19/2024] [Accepted: 02/22/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND While a growing number of studies examined the effect of e-cigarette (EC) excise taxes on tobacco use behaviors using cross-sectional surveys or sales data, there are currently no studies that evaluate the impact of EC taxes on smoking and vaping transitions. METHODS Using data from the US arm of the 2016-2020 International Tobacco Control Four Country Smoking and Vaping Survey (ITC 4CV), we employed a multinomial logit model with two-way fixed effects to simultaneously estimate the impacts of cigarette/EC taxes on the change in smoking and vaping frequencies. RESULTS Our benchmark model suggests that a 10 % increase in cigarette taxes led to an 11 % reduction in smoking frequencies (p < 0.01), while EC taxes did not have a significant effect on smoking frequencies. CONCLUSION Our findings suggest that increasing cigarette taxes may serve as an effective means of encouraging people who smoke to cut back on smoking or quit smoking. The impact of increasing EC taxes on smoking transitions is less certain at this time.
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Affiliation(s)
- Yanyun He
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada; School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Andrew Hyland
- Department of Health Behaviors, Division of Cancer Prevention and Population Sciences, Roswell Park Comprehensive Cancer Center, USA
| | - Ce Shang
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Internal Medicine, Medical Oncology Division, The Ohio State University, Columbus, OH, USA
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5
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Carpenter MJ, Cummings KM, Smith TT. Response to: Clinical trial shows that giving smokers free e-cigarettes creates more dual users than switchers or quitters. EClinicalMedicine 2024; 68:102451. [PMID: 38328753 PMCID: PMC10847052 DOI: 10.1016/j.eclinm.2024.102451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 02/09/2024] Open
Affiliation(s)
| | | | - Tracy T. Smith
- Hollings Cancer Center, Medical University of South Carolina, SC, USA
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6
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Paulin LM, Halenar MJ, Edwards KC, Lauten K, Taylor K, Brunette M, Tanski S, MacKenzie T, Stanton CA, Hatsukami D, Hyland A, Mahoney MC, Niaura R, Trinidad D, Blanco C, Compton W, Gardner LD, Kimmel HL, Cummings KM, Lauterstein D, Roh EJ, Marshall D, Sargent JD. Relationship Between Tobacco Product Use and Health-Related Quality of Life Among Individuals With COPD in Waves 1-5 (2013-2019) of the Population Assessment of Tobacco and Health Study. Chronic Obstr Pulm Dis 2024; 11:68-82. [PMID: 38113525 PMCID: PMC10913919 DOI: 10.15326/jcopdf.2023.0422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/06/2023] [Indexed: 12/21/2023]
Abstract
Introduction We examined the association between tobacco product use and health-related quality of life (HRQoL) among individuals with chronic obstructive pulmonary disease (COPD) in Waves 1-5 of the Population Assessment of Tobacco and Health (PATH) Study. Methods Adults ≥40 years with an ever COPD diagnosis were included in cross-sectional (Wave 5) and longitudinal (Waves 1 to 5) analyses. Tobacco use included 13 mutually exclusive categories of past 30-day (P30D) single use and polyuse with P30D exclusive cigarette use and ≥5-year cigarette cessation as reference groups. Multivariable linear regression and generalized estimating equations (GEE) were used to examine the association between tobacco use and HRQoL as measured by the Patient-Reported Outcomes Measurement Information System (PROMIS) Global-10 questionnaire. Results Of 1670 adults, 79.4% ever used cigarettes; mean (standard error [SE]) pack years was 30.9 (1.1). In cross-sectional analysis, P30D exclusive cigarette use, and e-cigarette/cigarette dual use were associated with worse HRQoL compared to ≥5-year cigarette cessation. Compared to P30D exclusive cigarette use, never tobacco use and ≥5-year cigarette cessation were associated with better HRQoL, while e-cigarette/cigarette dual use had worse HRQoL. Longitudinally (n=686), e-cigarette/cigarette dual use was associated with worsening HRQoL compared to both reference groups. Only never tobacco use was associated with higher HRQoL over time compared to P30D exclusive cigarette use. Conclusions E-cigarette/cigarette dual use was associated with worse HRQoL compared to ≥5-year cigarette cessation and exclusive cigarette use. Never use and ≥5-year cigarette cessation were the only categories associated with higher HRQoL compared to exclusive cigarette use. Findings highlight the importance of complete smoking cessation for individuals with COPD.
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Affiliation(s)
- Laura M. Paulin
- Geisel School of Medicine at Dartmouth, The C. Everett Koop Institute at Dartmouth, Hanover, New Hampshire, United States
| | - Michael J. Halenar
- Behavioral Health and Health Policy Practice, Westat, Rockville, Maryland, United States
| | - Kathryn C. Edwards
- Behavioral Health and Health Policy Practice, Westat, Rockville, Maryland, United States
| | - Kristin Lauten
- Behavioral Health and Health Policy Practice, Westat, Rockville, Maryland, United States
| | - Kristie Taylor
- Behavioral Health and Health Policy Practice, Westat, Rockville, Maryland, United States
| | - Mary Brunette
- Geisel School of Medicine at Dartmouth, The C. Everett Koop Institute at Dartmouth, Hanover, New Hampshire, United States
| | - Susanne Tanski
- Geisel School of Medicine at Dartmouth, The C. Everett Koop Institute at Dartmouth, Hanover, New Hampshire, United States
| | - Todd MacKenzie
- Geisel School of Medicine at Dartmouth, The C. Everett Koop Institute at Dartmouth, Hanover, New Hampshire, United States
| | - Cassandra A. Stanton
- Behavioral Health and Health Policy Practice, Westat, Rockville, Maryland, United States
| | - Dorothy Hatsukami
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, United States
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States
| | - Martin C. Mahoney
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States
| | - Ray Niaura
- School of Global Public Health, New York University, New York, New York, United States
| | - Dennis Trinidad
- University of California at San Diego, La Jolla, California, United States
| | - Carlos Blanco
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, United States
| | - Wilson Compton
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, United States
| | - Lisa D. Gardner
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland, United States
| | - Heather L. Kimmel
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, United States
| | - K. Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Dana Lauterstein
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland, United States
| | - Esther J. Roh
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland, United States
| | - Daniela Marshall
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, United States
- Axle Informatics, Rockville, Maryland, United States
| | - James D. Sargent
- Geisel School of Medicine at Dartmouth, The C. Everett Koop Institute at Dartmouth, Hanover, New Hampshire, United States
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7
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Sharma E, Tang Z, Lauten K, Silveira ML, Delnevo CD, Edwards KC, Marshall D, Gaalema DE, Zandberg I, Graham-Glover B, Rivers DL, Imoisili OE, Neal K, Niaura R, Bansal-Travers M, Hyland A, Michael Cummings K. Cardiovascular disease outcomes among established cigar users 40 years and older: Findings from the population assessment of tobacco and health (PATH) study, waves 1-5 (2013-2019). Prev Med Rep 2024; 37:102569. [PMID: 38186661 PMCID: PMC10767260 DOI: 10.1016/j.pmedr.2023.102569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/15/2023] [Accepted: 12/16/2023] [Indexed: 01/09/2024] Open
Abstract
This study examined associations between established cigar use and prevalence and incidence of cardiovascular diseases (CVD; congestive heart failure, stroke, or heart attack/needed bypass surgery) among U.S. adults, 40 years or older. Using Waves 1-5 (2013-2019) of the Population Assessment of Tobacco and Health (PATH) Study, incidence (Nindividuals (Nind) = 6,692; Nobservations (Nobs) = 23,738) and prevalence (Nind = 7,819; Nobs = 33,952) of CVD outcomes were examined using weighted generalized estimating equations (WGEEs) among adults who were exclusive current/former established cigar smokers (ever cigar smokers who have smoked fairly regularly), exclusive current/former established cigarette smokers (lifetime smokers of 100 or more cigarettes), dual current/former established cigarette and cigar smokers compared with never smokers of cigars or cigarettes, adjusting for covariates. The population-averaged incidence of CVD from one wave to next among exclusive current/former established cigar smokers during a six-year period based on WGEEs was low (overall average rate of 3.0 %; 95 % CI: 1.2, 7.0). Compared with never users, exclusive current/former established cigar smokers (OR = 1.67, 95 % CI: 1.11, 2.51) and exclusive current/former established cigarette smokers (OR = 2.12, 95 % CI: 1.45, 3.09) were more likely to have any CVD outcome in unadjusted analyses. When adjusted for covariates, only exclusive current/former established cigarette use was associated with CVD outcomes (AOR = 1.60, CI: 1.07, 2.40). Results suggest that exclusive established use of cigars or duration of exclusive cigar use was not associated with lifetime CVD prevalence compared with never cigar or cigarette smokers, which is important in understanding health outcomes in cigar users.
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Affiliation(s)
| | | | | | - Marushka L. Silveira
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
- Kelly Government Solutions, Rockville, MD, USA
| | - Cristine D. Delnevo
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, Rutgers University, New Brunswick, NJ, USA
| | | | - Daniela Marshall
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
- Axle Informatics, Rockville, MD, USA
| | - Diann E. Gaalema
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Izabella Zandberg
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Bria Graham-Glover
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Derick L. Rivers
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Omoye E. Imoisili
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Kirstie Neal
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Raymond Niaura
- Department of Social and Behavioral Sciences, NYU College of Global Public Health, New York University, NY, USA
| | - Maansi Bansal-Travers
- Department of Health Behavior, Division of Cancer Prevention & Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Andrew Hyland
- Department of Health Behavior, Division of Cancer Prevention & Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - K. Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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8
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Fairman RT, Cho YJ, Popova L, Cummings KM, Smith TT, Fong GT, Gravely S, Borland R, McNeill A, Gartner CE, Morphett K, Thrasher JF. Support for nicotine reduction in cigarettes: findings from the 2016 and 2020 ITC Four Country Smoking and Vaping Surveys. Tob Control 2023:tc-2023-058128. [PMID: 38071523 DOI: 10.1136/tc-2023-058128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 11/21/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION The USA and New Zealand have sought to establish a product standard to set a maximum nicotine level for cigarettes to reduce their addictiveness. This study examined support for very low nicotine cigarettes (VLNCs) in Australia, Canada, England and the USA between 2016 and 2020. METHODS Repeated cross-sectional data were analysed from participants who currently smoke, formerly smoked or vaped and/or currently vape in the 2016 (n=11 150) and/or 2020 (n=5432) International Tobacco Control (ITC) Four Country Smoking and Vaping Survey. Respondents were asked if they would support a law that reduces the amount of nicotine in cigarettes to make them less addictive. Adjusted and weighted logistic regression analyses estimated the prevalence and predictors of support, such as country, age, sex, education, income, race and smoking/vaping status for VLNCs (support vs oppose/do not know). RESULTS A majority of respondents supported a VLNC law, with support highest in Canada (69%; 2016 and 2020 combined), followed by England (61%), Australia (60%) and the USA (58%). Overall, support decreased from 62% in 2016 to 59% in 2020 (p=0.004), which did not differ by country. Levels of support differed by smoking/vaping status, where those who exclusively smoked daily showed the lowest level of support (59%) and those who exclusively vaped non-daily had the highest level of support (72%). CONCLUSION More than half of respondents in all four countries-including those who smoked daily-supported a hypothetical VLNC standard to render cigarettes less addictive. It is important to examine if support is sustained after policies are implemented.
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Affiliation(s)
| | - Yoo Jin Cho
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Lucy Popova
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - K Michael Cummings
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Tracy T Smith
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Ron Borland
- School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Ann McNeill
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - Coral E Gartner
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Kylie Morphett
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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Liu C, Yong HH, Gravely S, East K, Kasza K, Gartner C, Cummings KM, Fong GT. Gender differences in cigarette smoking cessation attempts among adults who smoke and drink alcohol at high levels: Findings from the 2018-2020 International Tobacco Control Four Country Smoking and Vaping Surveys. Addict Behav 2023; 147:107817. [PMID: 37536221 PMCID: PMC10866688 DOI: 10.1016/j.addbeh.2023.107817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/16/2023] [Accepted: 07/27/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND This study examined the association between alcohol consumption and smoking cessation behaviour of adults who smoke in four countries. METHODS Data came from 4275 adults (≥18 years) who smoked tobacco ≥ monthly and participated in the 2018 and 2020 International Tobacco Control Four Country Smoking and Vaping Surveys (Australia: n = 720; Canada: n = 1250; US: n = 1011; England: n = 1294). The 2018 Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) survey data coded into three levels ('never/low', 'moderate' or 'heavy' consumption) were analysed using multivariable logistic regression models to predict any smoking cessation attempts and successful cessation by 2020 survey, and whether this differed by gender and country. RESULTS Compared to never/low alcohol consumers, only those who drink heavily were less likely to have made a quit smoking attempt (40.4 % vs. 43.8 %; AOR = 0.69, 95 % CI = 0.57-0.83, p < .001). The association differed by gender and country (3-way interaction, p < .001), with females who drink heavily being less likely to attempt to quit smoking in England (AOR = 0.27, 95 % CI = 0.15-0.49, p < .001) and Australia (AOR = 0.38, 95 % CI = 0.19-0.77, p = .008), but for males, those who drink moderately (AOR = 2.18, 95 % CI = 1.17-4.06, p = .014) or heavily (AOR = 2.61, 95 % CI = 1.45-4.68, p = .001) were more likely to make a quit attempt in England only. Alcohol consumption did not predict quit success. CONCLUSION Heavy alcohol use among adults who smoke appears to only undermine the likelihood of trying to quit smoking with some variation by gender and country of residence, but not their chances of succeeding if they tried.
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Affiliation(s)
- Chenyang Liu
- School of Psychology, Deakin University, Geelong, Victoria, Australia.
| | - Hua-Hie Yong
- School of Psychology, Deakin University, Geelong, Victoria, Australia.
| | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada.
| | - Katherine East
- National Addiction Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
| | - Karin Kasza
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA.
| | - Coral Gartner
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA.
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada; School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada; Ontario Institute for Cancer Research, Toronto, Ontario M5G 0A3, Canada.
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Freitas-Lemos R, Tegge AN, Tomlinson DC, Yeh YH, Stein JS, Michael Cummings K, Fong GT, Shields PG, Hatsukami DK, Bickel WK. Illegal product purchasing in the experimental tobacco marketplace: Effects of menthol cigarette and cigarette ventilation ban. Drug Alcohol Depend 2023; 253:111015. [PMID: 37951005 PMCID: PMC10885639 DOI: 10.1016/j.drugalcdep.2023.111015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/02/2023] [Accepted: 10/23/2023] [Indexed: 11/13/2023]
Abstract
BACKGROUND Tobacco regulations may increase demand for illegal cigarettes. We use the Experimental Tobacco Marketplace to estimate the impact of banning menthol cigarettes (Experiment 1) and decreasing allowable cigarette filter ventilation levels (Experiment 2). METHODS Crowdsourced participants were randomized into one of four groups (2×2 factorial design). Experiment 1 included menthol availability (yes/no) by purchasing option (legal only vs illegal available). Experiment 2 included filter-vented cigarettes availability (yes/no) by purchasing option (legal only vs illegal available). Participants were given an individualized budget to purchase tobacco. Percent budget spent was the outcome measure. RESULTS Experiment 1, with a legal marketplace only, non-menthol cigarette purchasing was lower (p=0.010) and electronic-cigarette purchasing was higher (p=0.016), when cigarettes were banned compared to when they were available. With an illegal marketplace, switching to legal non-menthol cigarettes was less likely (p<0.001) and purchasing illegal menthol cigarettes was higher (p<0.001), when cigarettes were banned compared to when they were available. Experiment 2, with a legal marketplace only, cigarette purchasing was lower (p=0.010), when the participant's filtered vented cigarettes were banned compared to when they were available. With an illegal marketplace, purchasing the legal low-ventilated cigarette option was lower (p<0.001) and significant differences in illegal filter-vented cigarette purchasing were not observed, when their filter-vented cigarettes were banned compared to when they were available legally. CONCLUSIONS Without an illegal option, both restrictions decreased cigarette purchasing, but the menthol ban increased e-cigarette purchasing. With an illegal option, a menthol ban increased illegal cigarette purchasing, but decreasing filter ventilation did not.
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Affiliation(s)
| | - Allison N Tegge
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA; Department of Statistics, Virginia Tech, Blacksburg, VA, USA
| | - Devin C Tomlinson
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA; Graduate Program in Translational Biology, Medicine, and Health, Virginia Tech, Blacksburg, VA, USA
| | - Yu-Hua Yeh
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
| | - Jeffrey S Stein
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Geoffrey T Fong
- Department of Psychology and School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada; Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Peter G Shields
- Comprehensive Cancer Center, The Ohio State University and James Cancer Hospital, Columbus, OH, USA
| | - Dorothy K Hatsukami
- Masonic Cancer Center and Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Warren K Bickel
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA.
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Levy DT, Cadham CJ, Yuan Z, Li Y, Gravely S, Cummings KM. Comparison of smoking prevalence in Canada before and after nicotine vaping product access using the SimSmoke model. Can J Public Health 2023; 114:992-1005. [PMID: 37540451 PMCID: PMC10661672 DOI: 10.17269/s41997-023-00792-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 05/29/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVES The public health impact of nicotine vaping products (NVPs) is subject to complex transitions between NVP and cigarette use. To circumvent the data limitations and parameter instability challenges in modeling transitions, we indirectly estimate NVPs' impact on smoking prevalence and resulting smoking-attributable deaths using the SimSmoke simulation model. METHODS Canada SimSmoke uses age- and sex-specific data on Canadian population, smoking prevalence and tobacco control policies. The model incorporates the impact of cigarette-oriented policies on smoking prevalence but not the explicit contribution of NVPs. The model was calibrated from 1999 to 2012, thereby projecting smoking prevalence before NVPs were widely used in Canada. The NVP impact on smoking prevalence is inferred by comparing projected 2012-2020 smoking trends absent NVPs to corresponding trends from two Canadian national surveys. We further distinguish impacts before and after NVPs became regulated in 2018 and more available. RESULTS Comparing 2012-2020 survey data of post-NVP to SimSmoke projected smoking prevalence trends, one survey indicated an NVP-related relative reduction of 15% (15%) for males (females) age 15+, but 32% (52%) for those ages 15-24. The other survey indicated a 14% (19%) NVP-related smoking reduction for ages 18+, but 42% (53%) for persons ages 18-24. Much of the gain occurred since Canada relaxed NVP restrictions. NVP-related 2012-2020 smoking reductions yielded 100,000 smoking-attributable deaths averted from 2012 to 2060. CONCLUSION Smoking prevalence in Canada, especially among younger adults, declined more rapidly once NVPs became readily available. The emergence of NVPs into the Canadian marketplace has not slowed the decline in smoking.
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Affiliation(s)
- David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA.
| | - Christopher J Cadham
- Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Zhe Yuan
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Yameng Li
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
| | - K Michael Cummings
- Department of Psychiatry & Behavioral Science, Medical University of South Carolina, Charleston, SC, USA
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Levy DT, Thirlway F, Sweanor D, Liber A, Maria Sanchez-Romero L, Meza R, Douglas CE, Michael Cummings K. Do Tobacco Companies Have an Incentive to Promote "Harm Reduction" Products?: The Role of Competition. Nicotine Tob Res 2023; 25:1810-1821. [PMID: 36692328 PMCID: PMC10664083 DOI: 10.1093/ntr/ntad014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 12/19/2022] [Accepted: 01/23/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION Some cigarette companies have started to talk about replacing cigarettes with less harmful alternatives, which might include nicotine vaping products (NVPs), heated tobacco products (HTPs), and oral nicotine delivery products. We consider market competition as a primary driver of whether cigarette companies follow through on their stated intentions. AIMS AND METHODS We focus on the behavior of cigarette companies in the United States. We compare competition in the pre- and post-2012 time periods, analyze the impact of the growth in NVPs on smoking prevalence and cigarette company profits, and examine the potential future role of competition. RESULTS Since 2006, consumers have broadened their use of non-combustible nicotine delivery products (NCNDPs) to include, inter alia, NVPs, HTPs, and oral nicotine pouches. U.S. cigarette companies have acquired major stakes in each of these product categories which corresponds to a period of rapidly declining adult smoking prevalence, especially among younger adults (ages 18-24 years). The shifting dynamics of the nicotine product marketplace are also reflected in cigarette company stock prices. While cigarette companies are likely to promote HTPs and nicotine delivery products over NVPs, their incentives will be directly related to competition from independent firms, which in turn will depend on government regulation. CONCLUSIONS Although cigarette companies will back alternatives to combusted tobacco when threatened by competition, the prospects for their lasting conversion to NCNDPs will depend on the extent of such competition, which will be influenced by government regulation of tobacco products. IMPLICATIONS Regulations that limit competition from independent firms while also protecting cigarette company profits risk slowing or even reversing recent declines in smoking, especially among youth and young adults. Regulations that reduce the appeal and addictiveness of combusted tobacco products, such as higher cigarette taxes or a reduced nicotine standard, will encourage smokers to quit and/or switch to less harmful non-combusted forms of tobacco. The regulation of non-combustible nicotine delivery products and cigarettes should be proportionate to their relative risks, so that smokers have incentives to switch from combustibles to safer alternatives, and cigarette companies have incentives to promote safer products.
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Affiliation(s)
- David T Levy
- Oncology Department, Lombardi Comprehensive Center, Georgetown University, Washington, DC, USA
| | | | - David Sweanor
- Centre for Health Law, Policy and Ethics, University of Ottawa, Ottawa, Ontario, Canada
| | - Alex Liber
- Oncology Department, Lombardi Comprehensive Center, Georgetown University, Washington, DC, USA
| | | | - Rafael Meza
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Clifford E Douglas
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charlestown, SC, USA
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13
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Levy DT, Warner KE, Liber AC, Travis N, Sweanor DT, Meza R, Cummings KM. Potential Implications for Tobacco Industry Transformation of the Acquisition of Swedish Match by Philip Morris International. Nicotine Tob Res 2023; 25:1899-1903. [PMID: 37535864 PMCID: PMC10664079 DOI: 10.1093/ntr/ntad138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 06/25/2023] [Accepted: 08/02/2023] [Indexed: 08/05/2023]
Abstract
Philip Morris International's recent purchase of Swedish Match may prove to be a vital tobacco industry development. We focus on PMIs potential progress in moving from primarily selling cigarettes toward primarily selling noncombustible nicotine delivery products (NCNDPs). We also consider the potential contribution of the acquisition to industry transformation whereby other cigarette firms may potentially move toward primarily selling NCNDPs. We examine the potential impact on noncombustible nicotine delivery product use, including nicotine pouches (a major Swedish Match product), e-cigarettes, heated tobacco products, and, most importantly, on sales of the industry's staple, combustible cigarettes. We focus on the United States as a special case, where PMI is limited from entering the cigarette market. Implications: Philip Morris International's purchase of Swedish Match and policies regarding nicotine pouches (NPs) have been overlooked in the tobacco control literature. The acquisition indicates the importance of the NP market to the largest nonstate-owned tobacco company. The acquisition has the potential through pricing and marketing tactics to either encourage or discourage the use of NPs, e-cigarettes, heated tobacco products, and most importantly cigarettes. Due to its inability to sell cigarettes in the United States, PMI will have incentives to use its alternative nicotine delivery products, including its newly acquired NPs, to reduce the sale of cigarettes by other companies. However, the potential effects in other countries, where PMI does sell cigarettes, are less clear. Monitoring and analyzing tobacco company acquisitions is essential to studying future transitions in using different kinds of tobacco products, especially from cigarettes to lower-risk alternative nicotine delivery products.
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Affiliation(s)
- David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Kenneth E Warner
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Alex C Liber
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Nargiz Travis
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - David T Sweanor
- Centre for Health Law, Policy & Ethics, University of Ottawa, Ottawa, Canada
| | - Rafael Meza
- Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, Canada
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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Roberson A, Cummings KM, Reid JL, Burkhalter R, Gravely S, East K, Thrasher JF, Hammond D. Trends in E-Cigarette and Tobacco Cigarette Purchasing Behaviors by Youth in the United States, Canada, and England, 2017-2022. Int J Public Health 2023; 68:1606234. [PMID: 38033762 PMCID: PMC10682085 DOI: 10.3389/ijph.2023.1606234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 10/25/2023] [Indexed: 12/02/2023] Open
Abstract
Objectives: This paper describes trends in youth e-cigarette (EC) and tobacco cigarette (TC) purchasing behaviors in Canada, England, and the United States (US) in relationship to changing minimum legal age (MLA) laws. Methods: Data are from eight cross-sectional online surveys among national samples of 16- to 19-year-olds in Canada, England, and the US conducted from 2017 to 2022 (N = 104,467). Average wave percentage change in EC and TC purchasing prevalence and purchase locations were estimated using Joinpoint regressions. Results: EC purchasing increased between 2017 and 2022, although the pattern of change differed by country. EC purchasing plateaued in 2019 for the US and in 2020 for Canada, while increasing through 2022 for England. TC purchasing declined sharply in the US, with purchasing from traditional retail locations declining, while purchasing from social sources increased. Vape shops were the most common location for EC purchasing, although declining in England and the US. Conclusion: Trends in EC and TC purchasing trends in the US are consistent with the expected impact of the federal MLA law increasing the legal age to 21 years in December 2019.
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Affiliation(s)
- Avery Roberson
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - K Michael Cummings
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Jessica L Reid
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Robin Burkhalter
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
| | - Katherine East
- National Addiction Centre, Institute of Psychiatry and Neuroscience, King's College London, London, England
| | - James F Thrasher
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
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15
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Fong GT, Chung-Hall J, Meng G, Craig LV, Thompson ME, Quah ACK, Cummings KM, Hyland A, O'Connor RJ, Levy DT, Delnevo CD, Ganz O, Eissenberg T, Soule EK, Schwartz R, Cohen JE, Chaiton MO. Impact of Canada's menthol cigarette ban on quitting among menthol smokers: pooled analysis of pre-post evaluation from the ITC Project and the Ontario Menthol Ban Study and projections of impact in the USA. Tob Control 2023; 32:734-738. [PMID: 35483720 PMCID: PMC9613818 DOI: 10.1136/tobaccocontrol-2021-057227] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/14/2022] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Between 2015 and 2018, Canada banned menthol cigarettes. This study pooled data from two pre-post cohort studies (the Ontario Menthol Ban Study, and the International Tobacco Control Policy Evaluation (ITC) Canada Survey, conducted in seven provinces) to derive more precise estimates of the impact of Canada's menthol ban on quitting and to apply these estimates to project the impact of a menthol ban in the USA. METHODS Weighted multivariable logistic analyses compared post-ban quit success of menthol smokers with non-menthol smokers (for daily smokers and for all (daily + non-daily) smokers), controlling for sex, age, ethnicity, education, baseline smoking status, baseline cigarettes per day and study regions. Projections to the USA were created by multiplying the effect size of the Canadian menthol ban on quitting (percentage of increased quitting among menthol smokers) by the number of menthol smokers overall and among African Americans, from the 2019 National Survey on Drug Use and Health. RESULTS After the menthol cigarette ban, menthol smokers were more likely than non-menthol smokers to have quit smoking among daily smokers (difference=8.0%; 95% CI: 2.4% to 13.7%,p=0.005) and all (daily+non-daily) smokers (difference=7.3%; 95% CI: 2.1% to 12.5%,p=0.006). The projected number of smokers who would quit after a US menthol ban would be 789 724 daily smokers (including 199 732 African Americans) and 1 337 988 daily+non-daily smokers (including 381 272 African Americans). CONCLUSIONS This pooled analysis of Canada's menthol cigarette ban provides the foundation for estimating the impact of menthol bans in the USA and other countries. Projections suggest that a US menthol cigarette ban would have a substantial impact on increasing quitting.
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Affiliation(s)
- Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
- School of Public Health Systems, University of Waterloo, Waterloo, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Janet Chung-Hall
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Gang Meng
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Lorraine V Craig
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Mary E Thompson
- Department of Statistics & Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Anne C K Quah
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - K Michael Cummings
- Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA
| | - Cristine D Delnevo
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, New Jersey, USA
| | - Ollie Ganz
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, New Jersey, USA
| | - Thomas Eissenberg
- Psychology and Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Eric K Soule
- Department of Health Education and Promotion, East Carolina University, Greenville, North Carolina, USA
| | - Robert Schwartz
- Ontario Tobacco Research Unit, University of Toronto, Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Joanna E Cohen
- Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Michael O Chaiton
- Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada
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Fix BV, Wackowski OA, Sharma A, Diaz D, Bansal-Travers M, Cummings KM, Rees VW, Hatsukami DK, O'Connor RJ. Perceived Truthfulness of Reduced Lung Cancer Risk Advertising Claims Influences Consumers' Intention to try and to Purchase Snus. Tob Use Insights 2023; 16:1179173X231206042. [PMID: 37842177 PMCID: PMC10576425 DOI: 10.1177/1179173x231206042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 09/20/2023] [Indexed: 10/17/2023] Open
Abstract
The objective of the current study was to evaluate the impact of a reduced risk claim about lung cancer, presented in various formats, on smokers' and non-smokers' interest in trying Camel Snus and intention to purchase Camel Snus. We varied claim formats by varying advertising messages for Camel Snus in 4 ways (1) text only; (2) bar chart; (3) text/testimonial; and (4) bar chart/testimonial. 3001 participants were recruited from a web-based consumer specialty panel via an email invitation. In 2015, a second study was conducted, using similar methods, where 3001 additional participants were recruited. Overall, controlling for other factors, the presence of an MRTP claim was not significantly related to interest in trying snus [X2 (4) = 8.567, P = .073], or purchase intentions [X2 (4) = 1.148, P = .887]. Relative to a control ad where no explicit health risk claim was made, the Graphic + testimonial [OR = 1.29] or Text only [OR = 1.41] claims did significantly increase interest in trying Camel Snus. However, the adverting format did not impact interest in purchasing Camel Snus. While current smokeless tobacco users (95%) and smokers (59%) expressed interest in trying Camel Snus, non-tobacco users (7%) showed low interest in trying or purchasing Camel Snus (P < .001). Interest in trying Camel Snus was stronger in younger smokers compared to older smokers. Among current smokers, worry about lung cancer (the key focus of the reduced risk claim) was not associated with interest in trying Camel Snus or with purchase intention [OR = .91, 95% CI: .72, 1.14] or intention to purchase snus [OR = 1.07, 95% CI: .86, 1.32]. Future research should evaluate how claim and messaging formats influence perceived truthfulness and whether this effect differs among sub-groups of consumers, such as adolescents, those with tobacco-related disease, and former smokers. It will also be helpful to understand whether perceptions of ad truthfulness result in changes in product use patterns over time. In sum, giving people truthful, credible information about relative product risks, such as through authorized MRTP claims, is important, but such information is likely insufficient to get smokers to switch.
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Affiliation(s)
- Brian V Fix
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Olivia A Wackowski
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Akshika Sharma
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Destiny Diaz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Maansi Bansal-Travers
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Vaughan W Rees
- Center for Global Tobacco Control, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Dorothy K Hatsukami
- Department of Psychiatry and Behavioral Sciences and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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Cummings KM, Talbot V, Roberson A, Bliss AA, Likins E, Brownstein NC, Stansell S, Adams-Ludd D, Harris B, Louder D, McCutcheon E, Zebian R, Rojewski A, Toll BA. Implementation of an "Opt-Out" Tobacco Treatment Program in Six Hospitals in South Carolina. Res Sq 2023:rs.3.rs-3318088. [PMID: 37720041 PMCID: PMC10503831 DOI: 10.21203/rs.3.rs-3318088/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Objective To describe the implementation an opt-out tobacco treatment program (TTP) in 6 diverse hospitals located in different regions of South Carolina. Methods Between March 8, 2021 and December 17, 2021, adult patients (≥ 18 years) admitted to 6 hospitals affiliated with the Medical University of South Carolina (MUSC) were screened for their cigarette status. Patients who smoked cigarettes were referred to an TTP offering a brief bedside consult and automated post-discharge follow-up calls with an opportunity to receive a referral to the South Carolina Quitline (SCQL). The hospitals included in this study ranged in size from 82 to 715 beds with diverse patient populations. Herein, we report on the results of screening and referring patients to the TTP, delivery of smoking cessation treatments, and patient smoking status assessed in a sample of patients followed 6-weeks after discharge from the hospital. Results Smoking prevalence ranged from 14-49% across the 6 hospitals. Among eligible patients reached, 85.6% accepted the bedside consult. Only 3.4% of patients reached were deemed ineligible because they claimed not to be currently smoking cigarettes. The automated post-discharge follow-up calls were answered by 43% of patients, with about a third of those who had relapsed back to smoking accepting the offer of a referral to the SCQL. Overall, about half of the 6,000 patients referred to the TTP received some type of treatment. Self-reported smoking abstinence rates assessed 6-weeks after discharge were similar across the five acute care hospitals ranging from about 20-30%. Conclusion The findings demonstrate the broad reach of implementing an opt-out TTP for patients in hospitals of varying size, rurality and patient populations.
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Strong DR, Pierce JP, White M, Stone MD, Abrams DB, Glasser AM, Wackowski OA, Cummings KM, Hyland A, Taylor K, Edwards KC, Silveira ML, Kimmel HL, Compton WM, Hull LC, Niaura R. Changes in Tobacco Dependence and Association With Onset and Progression of Use by Product Type From Waves 1 to 3 of the Population Assessment of Tobacco and Health (PATH) Study. Nicotine Tob Res 2023; 25:1781-1790. [PMID: 37410879 PMCID: PMC10475603 DOI: 10.1093/ntr/ntad107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 06/25/2023] [Accepted: 06/28/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION This study examined trajectories of tobacco dependence (TD) in relationship to changes in tobacco product use, and explored the effects of product-specific adding, switching, or discontinued use on dependence over time. AIMS AND METHODS Data were analyzed from the first three waves from the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative, longitudinal study of adults and youth in the United States. Data included 9556 wave 1 (2013-2014) adult current established tobacco users aged 18 or older who completed all three interviews and had established use at ≥2 assessments. Mutually exclusive groups included: users of cigarettes only, e-cigarettes only, cigars only, hookah only, any smokeless only, cigarette + e-cigarette dual users, and other multiple product users. A validated 16-item scale assessed TD across product users. RESULTS People who used e-cigarettes exclusively at wave 1 had small increases in TD through wave 3. Wave 1 multiple product users' TD decreased across waves. TD for all other wave 1 user groups remained about the same. For wave 1 cigarette only smokers, switching to another product was associated with lower levels of TD than smokers whose use stayed the same. Movement to no established use of any tobacco product was consistently associated with lower TD for all product users. CONCLUSIONS Except for wave 1 e-cigarette only users (who experienced small increases in TD), TD among U.S. tobacco product users was stable over time, with daily users less likely to vary from baseline. IMPLICATIONS The level of TD among most U.S. tobacco users was stable over the first three waves of the PATH Study and trends in levels of TD were predominantly unrelated to changes in patterns of continued product use. Stable levels of TD suggest a population at persistent risk of health impacts from tobacco. Wave 1 e-cigarette users experienced small increases in levels of TD over time, perhaps due to increases in quantity or frequency of their e-cigarette use or increasing efficiency of nicotine delivery over time.
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Affiliation(s)
- David R Strong
- Cancer Prevention and Control Program, Moores Cancer Center University of California, San Diego, CA, USA
- Department of Family Medicine and Public Health, University of California, San Diego, CA, USA
| | - John P Pierce
- Department of Family Medicine and Public Health, University of California, San Diego, CA, USA
| | - Martha White
- Cancer Prevention and Control Program, Moores Cancer Center University of California, San Diego, CA, USA
- Department of Family Medicine and Public Health, University of California, San Diego, CA, USA
| | - Matthew D Stone
- Department of Family Medicine and Public Health, University of California, San Diego, CA, USA
| | - David B Abrams
- School of Global Public Health, New York University, New York, NY, USA
| | - Allison M Glasser
- School of Global Public Health, New York University, New York, NY, USA
| | - Olivia A Wackowski
- Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, NJ, USA
| | - K Michael Cummings
- Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Andrew Hyland
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Buffalo, NY, USA
| | | | | | - Marushka L Silveira
- Kelly Government Solutions, Rockville, MD, USA
- National Institute of Dental and Craniofacial Research (NIDCR/NIH), Bethesda, MD, USA
| | | | | | - Lynn C Hull
- Center for Tobacco Products, FDA, Silver Spring, MD, USA
| | - Raymond Niaura
- School of Global Public Health, New York University, New York, NY, USA
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Bierut LJ, Hendershot TP, Benowitz NL, Cummings KM, Mermelstein RJ, Piper ME, Vrieze SI, Wagener TL, Nelms MD, Ives C, Maiese D, Hamilton CM, Swan GE. Smoking cessation, harm reduction, and biomarkers protocols in the PhenX Toolkit: Tools for standardized data collection. Addict Neurosci 2023; 7:100081. [PMID: 38645895 PMCID: PMC11027214 DOI: 10.1016/j.addicn.2023.100081] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
The use of standard protocols in studies supports consistent data collection, improves data quality, and facilitates cross-study analyses. Funded by the National Institutes of Health, the PhenX (consensus measures for Phenotypes and eXposures) Toolkit is a catalog of recommended measurement protocols that address a wide range of research topics and are suitable for inclusion in a variety of study designs. In 2020, a PhenX Working Group of smoking cessation experts followed a well-established consensus process to identify and recommend measurement protocols suitable for inclusion in smoking cessation and smoking harm reduction studies. The broader scientific community was invited to review and provide feedback on the preliminary recommendation of the Working Group. Fourteen selected protocols for measuring smoking cessation, harm reduction, and biomarkers research associated with smoking cessation were released in the PhenX Toolkit ( https://www.phenxtoolkit.org) in February 2021. These protocols complement existing PhenX Toolkit content related to tobacco regulatory research, substance use and addiction research, and other measures of smoking-related health outcomes. Adopting well-established protocols enables consistent data collection and facilitates comparing and combining data across studies, potentially increasing the scientific impact of individual studies.
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Affiliation(s)
- Laura Jean Bierut
- Department of Psychiatry, Washington University School of Medicine of St. Louis, 660 South Euclid, Campus Box 8134, St. Louis, MO 63110, USA
| | - Tabitha P. Hendershot
- RTI International, Center for GenOmics, Bioinformatics and Translational Research, Research Triangle Park, NC, USA
| | - Neal L. Benowitz
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - K. Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | | | - Megan E. Piper
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Madison, WI, USA
| | - Scott I. Vrieze
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Theodore L. Wagener
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Mark D. Nelms
- RTI International, Center for GenOmics, Bioinformatics and Translational Research, Research Triangle Park, NC, USA
| | - Cataia Ives
- RTI International, Center for GenOmics, Bioinformatics and Translational Research, Research Triangle Park, NC, USA
| | - Deborah Maiese
- RTI International, Center for GenOmics, Bioinformatics and Translational Research, Research Triangle Park, NC, USA
| | - Carol M. Hamilton
- RTI International, Center for GenOmics, Bioinformatics and Translational Research, Research Triangle Park, NC, USA
| | - Gary E. Swan
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
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Carpenter MJ, Wahlquist AE, Dahne J, Gray KM, Cummings KM, Warren G, Wagener TL, Goniewicz ML, Smith TT. Effect of unguided e-cigarette provision on uptake, use, and smoking cessation among adults who smoke in the USA: a naturalistic, randomised, controlled clinical trial. EClinicalMedicine 2023; 63:102142. [PMID: 37753443 PMCID: PMC10518503 DOI: 10.1016/j.eclinm.2023.102142] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 09/28/2023] Open
Abstract
Background As summarised in the most recent Cochrane review, the few clinical trials on e-cigarettes are largely focused on smoking cessation. We aimed to determine the naturalistic uptake, use, and impact of e-cigarettes among adults who may or may not want to stop smoking. Methods In this naturalistic, randomised, controlled clinical trial, adult smokers, across the motivational spectrum and with minimal history of e-cigarette use, were recruited online from the general community within 11 cities across the USA. Participants were randomly assigned (2:1) to either receive either a free 4-week supply of flavoured, tank-style e-cigarette, or not. E-cigarette group participants received a battery and device with up to 30 pre-filled tanks, offered among five flavours, with minimal instructions on use. The study's primary purpose was to descriptively assess naturalistic uptake and usage of the e-cigarette, and to secondarily assess its impact on smoking behavior. The latter, assessed through six months of follow-up, included: a) self-reported 7-day point prevalence abstinence, b) incidence of quit attempts, and c) smoking reduction. This trial is registered at ClinicalTrials.gov, NCT03453385. Findings Between 5/2018 and 3/2022, 638 adult smokers were enrolled and randomly assigned (427 in the e-cigarette group and 211 in the no-product control group). Uptake of e-cigarettes was robust: approximately 70% of participants used the product, with average usage exceeding 4 days per week during the initial 30 days. Based on an intent-to-treat approach where missing data is imputed as smoking, almost all behavioral outcomes favored the e-cigarette group relative to no-product control, including point prevalence abstinence at six months (Odds Ratio [OR] = 1.8; 95% Confidence Interval [CI] = 1.0-3.1), cumulative incidence of 24-hr quit attempts (OR = 1.5; 95% CI = 1.0-2.2), and having reduced smoking by at least 50% since baseline (OR = 1.8; 95% CI = 1.2-2.7). Results were similar under an alternative imputation. Interpretation Complementing cessation-focused trials, results suggest that unguided e-cigarette use also leads to smoking cessation, allaying the notion that causal effects of e-cigarettes on cessation are not reflective of real-world scenario of self-determined use. For smokers who may not be able to quit using existing pharmacologic approaches, e-cigarettes may be considered to achive that purpose. Funding National Cancer Institute.
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Affiliation(s)
- Matthew J. Carpenter
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC, USA
- Department of Public Health Sciences, MUSC, Charleston, SC, USA
- Hollings Cancer Center, MUSC, Charleston, SC, USA
| | - Amy E. Wahlquist
- Center for Rural Health Research, East Tennessee State University, Johnson City, TN, USA
| | - Jennifer Dahne
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC, USA
- Hollings Cancer Center, MUSC, Charleston, SC, USA
| | - Kevin M. Gray
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC, USA
- Hollings Cancer Center, MUSC, Charleston, SC, USA
| | - K. Michael Cummings
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC, USA
- Department of Public Health Sciences, MUSC, Charleston, SC, USA
- Hollings Cancer Center, MUSC, Charleston, SC, USA
| | - Graham Warren
- Hollings Cancer Center, MUSC, Charleston, SC, USA
- Department of Radiation Oncology, MUSC, Charleston, SC, USA
| | - Theodore L. Wagener
- Department of Internal Medicine, Ohio State University (OSU), Columbus, OH, USA
- Center for Tobacco Research, OSU Comprehensive Cancer Center, Columbus, OH, USA
| | - Maciej L. Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, USA
| | - Tracy T. Smith
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC, USA
- Hollings Cancer Center, MUSC, Charleston, SC, USA
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21
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Strong DR, Glasser AM, Leas EC, Pierce JP, Abrams DB, Hrywna M, Hyland A, Cummings KM, Hatsukami DK, Fong GT, Elton-Marshall T, Sharma E, Edwards KC, Stanton CA, Sawdey MD, Ramôa CP, Silveira ML, Kimmel HL, Niaura RS. Indicators of Tobacco Dependence Among Youth: Findings From Wave 1 (2013-2014) of the Population Assessment of Tobacco and Health Study. Nicotine Tob Res 2023; 25:1565-1574. [PMID: 37156636 PMCID: PMC10439486 DOI: 10.1093/ntr/ntad072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 05/01/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Prior work established a measure of tobacco dependence (TD) among adults that can be used to compare TD across different tobacco products. We extend this approach to develop a common, cross-product metric for TD among youth. METHODS One thousand one hundred and forty-eight youth aged 12-17 who used a tobacco product in the past 30 days were identified from 13 651 youth respondents in Wave 1 of the Population Assessment of Tobacco and Health (PATH) Study. FINDINGS Analyses confirmed a single primary latent construct underlying responses to TD indicators for all mutually exclusive tobacco product user groups. Differential Item Functioning analyses supported the use of 8 of 10 TD indicators for comparisons across groups. With TD levels anchored at 0.0 (standard deviation [SD] = 1.0) among cigarette only (n = 265) use group, mean TD scores were more than a full SD lower for e-cigarette only (n = 150) use group (mean = -1.09; SD = 0.64). Other single product use group (cigar, hookah, pipe, or smokeless; n = 262) on average had lower TD (mean = -0.60; SD = 0.84), and the group with the use of multiple tobacco products (n = 471) experienced similar levels of TD (mean = 0.14; SD = 0.78) as the cigarette only use group. Concurrent validity was established with product use frequency among all user groups. A subset of five TD items comprised a common metric permitting comparisons between youth and adults. CONCLUSION The PATH Study Youth Wave 1 Interview provided psychometrically valid measures of TD that enable future regulatory investigations of TD across tobacco products and comparisons between youth and adult tobacco product use group. IMPLICATIONS A measure of tobacco dependence (TD) has been established previously among adults to compare TD across tobacco products. This study established the validity of a similar, cross-product measure of TD among youth. Findings suggest a single latent TD construct underlying this measure, concurrent validity of the scale with product use frequency across different types of tobacco users, and a subset of common items that can be used to compare TD between youth and adults who use tobacco.
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Affiliation(s)
- David R Strong
- Cancer Prevention and Control Program, Moores Cancer Center University of California, San Diego, CA, USA
- Department of Family Medicine and Public Health, University of California, San Diego, CA, USA
| | - Allison M Glasser
- School of Global Public Health, New York University, New York, NY, USA
| | - Eric C Leas
- Department of Family Medicine and Public Health, University of California, San Diego, CA, USA
| | - John P Pierce
- Department of Family Medicine and Public Health, University of California, San Diego, CA, USA
| | - David B Abrams
- School of Global Public Health, New York University, New York, NY, USA
| | - Mary Hrywna
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, New Brunswick, NJ, USA
| | | | | | - Dorothy K Hatsukami
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Geoffrey T Fong
- School of Public Health Sciences, University of Waterloo, Waterloo, ON,Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Tara Elton-Marshall
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | | | | | | | - Michael D Sawdey
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Carolina P Ramôa
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Marushka L Silveira
- Kelly Government Solutions, Rockville, MD, USA
- National Institute of Dental and Craniofacial Research (NIDCR/NIH), Bethesda, MD, USA
| | | | - Raymond S Niaura
- School of Global Public Health, New York University, New York, NY, USA
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22
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Yong HH, Karmakar C, Motin MA, Borland R, Cummings KM, Gravely S, Fong GT. Individual and Conjoint Factors Associated With Beliefs About the Harmfulness of Nicotine Replacement Therapies Relative to Combustible Cigarettes Among People Who Smoke: Findings From the 2020 ITC Four Country Smoking and Vaping Survey. Nicotine Tob Res 2023; 25:1594-1602. [PMID: 37195899 PMCID: PMC10439491 DOI: 10.1093/ntr/ntad075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 04/20/2023] [Accepted: 05/15/2023] [Indexed: 05/19/2023]
Abstract
INTRODUCTION This study examined individual and conjoint factors associated with beliefs about the harmfulness of nicotine replacement therapies (NRTs) relative to combustible cigarettes (CCs). AIMS AND METHODS Data analyzed came from 8642 adults (≥18 years) who smoked daily/weekly and participated in the 2020 ITC Four Country Smoking and Vaping Survey in Australia (n = 1213), Canada (n = 2633), England (n = 3057), and United States (n = 1739). Respondents were asked: "Compared to smoking cigarettes, how harmful do you think nicotine replacement products are?" Responses were dichotomized into "much less" versus otherwise for analysis using multivariable logistic regression models, complemented by decision-tree analysis to identify conjoint factors. RESULTS Percentages believing that NRTs are much less harmful than CCs were 29.7% (95% CI = 26.2% to 33.5%) in Australia, 27.4% (95% CI = 25.1% to 29.8%) in England, 26.4% (95% CI = 24.4% to 28.4%) in Canada, and 21.7% (95% CI = 19.2% to 24.3%) in the United States. Across all countries, believing nicotine is not at all/slightly harmful to health (aOR = 1.53-2.27), endorsing nicotine vaping products (NVPs) as less harmful than CCs (much less harmful: aOR = 7.24-14.27; somewhat less harmful: aOR = 1.97-3.23), and possessing higher knowledge of smoking harms (aOR = 1.23-1.88) were individual factors associated with increased odds of believing NRTs are much less harmful than CCs. With some country variations, these nicotine-related measures also interacted with each other and sociodemographic variables to serve as conjoint factors associated with the likelihood of accurate NRT relative harm belief. CONCLUSIONS Many people who regularly smoke cigarettes are unaware that NRTs are much less harmful than cigarettes. Additionally, beliefs about NRTs relative harmfulness appear to be influenced by both individual and conjoint factors. IMPLICATIONS This study demonstrates that despite past efforts to educate people who smoke about the harms of NRTs relative to CCs, misperceptions around the relative harmfulness of NRTs remain substantial. In all four studied countries, subgroups of people who smoke regularly who are misinformed about the relative harmfulness of NRTs, and who may be reluctant to use NRTs for smoking cessation can be reliably identified for corrective interventions based on their understanding of the harms related to nicotine, NVPs and smoking along with sociodemographic markers. The identified subgroup information can be used to prioritize and inform the development of effective interventions to specifically address the gaps in knowledge and understanding of the various subgroups identified. Our results suggest these may need to be tailored for each country.
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Affiliation(s)
| | | | | | | | | | | | - Geoffrey T Fong
- University of Waterloo, Waterloo, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
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Tildy BE, McNeill A, East K, Gravely S, Fong GT, Cummings KM, Borland R, Chan GCK, Lim CCW, Gartner C, Yong HH, Brose LS. Self-reported depression and anxiety and healthcare professional interactions regarding smoking cessation and nicotine vaping: Findings from 2018 International Tobacco Control Four Country Smoking and Vaping (ITC 4CV) Survey. Tob Prev Cessat 2023; 9:26. [PMID: 37533461 PMCID: PMC10391919 DOI: 10.18332/tpc/168288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 08/04/2023]
Abstract
INTRODUCTION People with mental health conditions are disproportionately affected by smoking-related diseases and death. The aim of this study was to assess whether health professional (HP) interactions regarding smoking cessation and nicotine vaping products (NVPs) differ by mental health condition. METHODS The cross-sectional 2018 International Tobacco Control Four Country (Australia, Canada, England, United States) Smoking and Vaping Survey data included 11040 adults currently smoking or recently quit. Adjusted weighted logistic regressions examined associations between mental health (self-reported current depression and/or anxiety) and visiting a HP in last 18 months; receiving advice to quit smoking; discussing NVPs with a HP; and receiving a recommendation to use NVPs. RESULTS Overall, 16.1% self-reported depression and anxiety, 7.6% depression only, and 6.6% anxiety only. Compared with respondents with no depression/anxiety, those with depression (84.7%, AOR=2.65; 95% CI: 2.17-3.27), anxiety (82.2%, AOR=2.08; 95% CI: 1.70-2.57), and depression and anxiety (87.6%, AOR=3.74; 95% CI: 3.19-4.40) were more likely to have visited a HP. Among those who had visited a HP, 47.9% received advice to quit smoking, which was more likely among respondents with depression (AOR=1.58; 95% CI: 1.34-1.86), and NVP discussions were more likely among those with depression and anxiety (AOR=1.63; 95% CI: 1.29-2.06). Of the 6.1% who discussed NVPs, 33.5% received a recommendation to use them, with no difference by mental health. CONCLUSIONS People with anxiety and/or depression who smoke were more likely to visit a HP than those without, but only those with depression were more likely to receive cessation advice, and only those with depression and anxiety were more likely to discuss NVPs. There are missed opportunities for HPs to deliver cessation advice. NVP discussions and receiving a positive recommendation to use them were rare overall.
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Affiliation(s)
- Bernadett E. Tildy
- Addictions Department, King’s College London, Addiction Sciences Building, London, United Kingdom
- SPECTRUM Consortium, London, United Kingdom
| | - Ann McNeill
- Addictions Department, King’s College London, Addiction Sciences Building, London, United Kingdom
- SPECTRUM Consortium, London, United Kingdom
| | - Katherine East
- Addictions Department, King’s College London, Addiction Sciences Building, London, United Kingdom
| | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Geoffrey T. Fong
- Department of Psychology, University of Waterloo, Waterloo, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
- Ontario Institute for Cancer Research, Toronto, Canada
| | - K. Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, United States
| | - Ron Borland
- School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Gary C. K. Chan
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioral Sciences, University of Queensland, Queensland, Australia
| | - Carmen C. W. Lim
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioral Sciences, University of Queensland, Queensland, Australia
- School of Psychology, Faculty of Health and Behavioral Sciences, University of Queensland, Queensland, Australia
| | - Coral Gartner
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, Faculty of Medicine, School of Public Health, University of Queensland, Herston, Australia
| | - Hua-Hie Yong
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Leonie S. Brose
- Addictions Department, King’s College London, Addiction Sciences Building, London, United Kingdom
- SPECTRUM Consortium, London, United Kingdom
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Carroll DM, Tessier KM, Cummings KM, O'Connor RJ, Reisinger S, Shields PG, Stepanov IS, Luo X, Hatsukami DK, Rees VW. Risk perceptions and continued smoking as a function of cigarette filter ventilation level among US youth and young adults who smoke. Tob Control 2023; 32:473-479. [PMID: 34857645 PMCID: PMC9160200 DOI: 10.1136/tobaccocontrol-2021-056833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 11/11/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND While evidence demonstrates that the industry's marketing of cigarettes with higher filter ventilation (FV) misleads adults about their health risks, there is no research on the relationships between FV, risk perceptions and smoking trajectories among youth (ages 12-17) and young adults (ages 18-24). METHODS Data on FV levels of major US cigarette brands/sub-brands were merged with the Population Assessment of Tobacco and Health Study to examine whether FV level in cigarettes used by wave 1 youth/young adults (n=1970) predicted continued smoking at waves 2-4, and whether those relationships were mediated by perceived risk of their cigarette brand. FV was modelled based on tertiles (0.2%-11.8%, low; 11.9%-23.2%, moderate; 23.3%-61.1%, high) to predict daily smoking, past 30-day smoking and change in number of days smoking at successive waves. RESULTS The odds of perceiving one's brand as less harmful than other cigarette brands was 2.21 times higher in the high versus low FV group (p=0.0146). Relationships between FV and smoking outcomes at successive waves were non-significant (all p>0.05). CONCLUSION Youth and young adults who use higher FV cigarettes perceived their brand as less harmful compared with other brands. However, level of FV was not associated with continued smoking.
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Affiliation(s)
- Dana Mowls Carroll
- Division of Environmental Health Sciences, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | | | - K Michael Cummings
- Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Sarah Reisinger
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Peter G Shields
- James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Irina S Stepanov
- Division of Environmental Health Sciences, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Xianghua Luo
- School of Public Health, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Dorothy K Hatsukami
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Vaughan W Rees
- Department of Social and Behavioral Sciences, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
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25
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Gravely S, Meng G, Hammond D, Driezen P, Thrasher JF, Fong GT, Craig LV, Chung-Hall J, Quah ACK, Ouimet J, Bansal-Travers M, Cummings KM. Support for pictorial health warning labels on cigarette packages in the United States among adults who currently smoke or quit smoking: Findings from the ITC US Smoking and Vaping Surveys. Tob Induc Dis 2023; 21:84. [PMID: 37360042 PMCID: PMC10288539 DOI: 10.18332/tid/166001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/18/2023] [Accepted: 05/08/2023] [Indexed: 06/28/2023] Open
Abstract
INTRODUCTION In March 2020, the US Food and Drug Administration (FDA) finalized new pictorial health warnings (PHWs), covering 50% of the front and back of the pack; however, legal challenges from cigarette manufacturers have prevented the new warnings from being implemented. About 70% of adults in the general US population support PHWs. This study assessed support for PHWs in 2016, 2018 and 2020 among US adults (aged ≥18 years) who currently smoke or formerly smoked cigarettes. We also assessed factors related to support. METHODS Respondents included adults who currently or formerly smoked cigarettes and participated in at least one wave of the US ITC Smoking and Vaping Surveys: Wave 1 (2016, n=2557); Wave 2 (2018, n=2685); and Wave 3 (2020, n=1112). We assessed changes in support for PHWs between 2016 and 2020, and assessed factors related to support (support vs oppose/don't know). Analyses were conducted on weighted data. RESULTS Overall, 38.0% of respondents supported PHWs in 2016, with a significant increase to 44.7% in 2018 (p<0.001), and leveling off to 45.0% in 2020 (2018 vs 2020, p=0.91). Support was highest among former smokers and lowest among daily smokers in all three survey years. Support for PHWs at all survey years was significantly higher among those who formerly smoked, were younger (aged 18-39 vs ≥40 years), those who identified as Black (vs White), and planned to quit smoking (vs not planning to quit). There were no differences by income level, education level, or sex. CONCLUSIONS Nearly half of US adults who smoke cigarettes or quit smoking supported PHWs in 2020, with support being higher among younger adults, ethnic minorities, and those who formerly smoked. Support increased between 2016 and 2018, but not between 2018 and 2020. Similar to other studies, fewer current and former smokers supported PHWs compared to the US adult general population.
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Affiliation(s)
- Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Gang Meng
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - James F. Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, United States
| | - Geoffrey T. Fong
- Department of Psychology, University of Waterloo, Waterloo, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
- Ontario Institute for Cancer Research, Toronto, Canada
| | | | - Janet Chung-Hall
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Anne C. K. Quah
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Janine Ouimet
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Maansi Bansal-Travers
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, United States
| | - K. Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, United States
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26
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Cummings KM, Roberson A, Carroll DM, Stepanov I, Hatsukami D, Rees VW, O’Connor RJ. Illusion of filtration: Evidence from tobacco industry documents. Tob Induc Dis 2023; 21:85. [PMID: 37360043 PMCID: PMC10288540 DOI: 10.18332/tid/166093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/05/2023] [Accepted: 05/11/2023] [Indexed: 06/28/2023] Open
Abstract
INTRODUCTION We compared the design features of popular filtered and non-filtered cigarettes sold in the United States between 1960 and 1990, to assess the relationship between cigarette filter and tobacco weight. METHODS We analyzed data on the design features of six popular filtered and three non-filtered cigarette brands sold in the US including the weight of tobacco used provided in the Cigarette Information Reports produced by Philip Morris Tobacco Company between 1960 and 1990. We also collected information on other design features such as stick length and circumference, the percentage of reconstituted tobacco in the blend, among other product parameters. We used joinpoint regression to test for trends in outcome variables for each brand assessed between 1960 and 1990. RESULTS In all years, filtered cigarettes had less tobacco by weight compared to non-filtered cigarettes. The lower average weight of tobacco found in filtered cigarettes appears to be due to a combination of factors including stick and filter length, and the amount of reconstituted tobacco in the blend. The average percentages of total alkaloids and expanded tobacco increased over time but were similar between filtered and non-filtered brands. CONCLUSIONS While various design features of popular filtered and non-filtered brands changed between 1960 and 1990, the observed reduction in tobacco weight among filtered brands was perhaps the most salient in terms of disease risk. Less tobacco in a filtered cigarette calls into question the presumed exclusive role of cigarette filter tips in the reduced health risks of filtered versus non-filtered cigarette smoking.
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Affiliation(s)
- K. Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, United States
| | - Avery Roberson
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, United States
| | - Dana M. Carroll
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, United States
| | - Irina Stepanov
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, United States
| | - Dorothy Hatsukami
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, United States
| | - Vaughan W. Rees
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, United States
| | - Richard J. O’Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, United States
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Gravely S, Yong HH, Reid JL, East KA, Liber AC, Michael Cummings K, Quah AC, Fong GT, Hammond D. An examination of quitting smoking as a reason for vaping by the type of nicotine vaping device used most often among adults who smoke and vape: Findings from the Canada, England and the United States 2020 ITC Smoking and Vaping Survey. Prev Med Rep 2023; 33:102201. [PMID: 37223550 PMCID: PMC10201827 DOI: 10.1016/j.pmedr.2023.102201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 05/25/2023] Open
Abstract
Several nicotine vaping product (NVP) device types are available to consumers, and many people who smoke report vaping to help them quit. This study included data from the Wave 3 (2020) ITC Smoking and Vaping Survey in the US, Canada, and England and included 2324 adults who were smoking cigarettes and vaping at least weekly. Device types currently used most often (disposables, cartridges/pods, or tank systems) were assessed using weighted descriptive statistics. Multivariable regression analyses were used to compare differences between respondents who reported vaping to quit smoking ('yes' vs. 'no/don't know') by device type, overall and by country. Overall, 71.3% of respondents reported vaping to help them quit smoking, with no country differences (p = 0.12). Those using tanks (78.7%, p < 0.001) and cartridges/pods (69.5%, p = 0.02) were more likely to report this reason for vaping than those using disposables (59.3%); respondents using tanks were also more likely than those using cartridges/pods (p = 0.001) to report this reason. By country, respondents in England using cartridges/pods or tanks (vs. disposables) were more likely to report vaping to quit smoking (with no difference between cartridges/pods and tanks). In Canada, respondents using tanks were more likely to report vaping to quit smoking than those using cartridges/pods or disposables (no difference between disposables and cartridges/pods). No significant differences by device type were found in the US. In conclusion, most adult respondents who smoked and vaped reported using either cartridges/pods or tanks, which were associated with greater odds of vaping for the purpose of quitting smoking versus disposables, with some country variations.
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Affiliation(s)
- Shannon Gravely
- Department of Psychology, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
| | - Hua-Hie Yong
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, Victoria 3220, Australia
| | - Jessica L. Reid
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
| | - Katherine A. East
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
- Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, Addictions Sciences Building, 4 Windsor Walk, Denmark Hill, London SE5 8BB, UK
| | - Alex C. Liber
- Lombardi Comprehensive Cancer Center, Georgetown University, 3800 Reservoir Rd NW, Washington, DC 20007, USA
| | - K. Michael Cummings
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, 67 President St., Charleston, SC 29425, USA
| | - Anne C.K. Quah
- Department of Psychology, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
| | - Geoffrey T. Fong
- Department of Psychology, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
- Ontario Institute for Cancer Research, 661 University Ave., Toronto, ON M5G 0A3, Canada
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
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Sargent JD, Edwards KC, Emond J, Tanski S, Taylor KA, Pierce JP, Goniewicz ML, Niaura R, Anic G, Chen Y, Callahan-Lyon P, Gardner LD, Thekkudan T, Borek N, Kimmel HL, Michael Cummings K, Hyland A, Brunette M. Author Response to E-cigarettes and Respiratory Disorder: The Broader Research Context. Nicotine Tob Res 2023; 25:1217-1218. [PMID: 36879402 PMCID: PMC10202629 DOI: 10.1093/ntr/ntad036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Indexed: 03/08/2023]
Affiliation(s)
- James D Sargent
- Geisel School of Medicine at Dartmouth, The C. Everett Koop Institute at Dartmouth, Lebanon, NH, USA
| | - Kathryn C Edwards
- Behavorial Health and Health Policy Practice, Westat, Rockville, MD, USA
| | - Jennifer Emond
- Geisel School of Medicine at Dartmouth, The C. Everett Koop Institute at Dartmouth, Lebanon, NH, USA
| | - Susanne Tanski
- Geisel School of Medicine at Dartmouth, The C. Everett Koop Institute at Dartmouth, Lebanon, NH, USA
| | - Kristie A Taylor
- Behavorial Health and Health Policy Practice, Westat, Rockville, MD, USA
| | - John P Pierce
- Cancer Control, Moore’s Cancer Center, University of California at San Diego, San Diego, CA, USA
| | - Maciej L Goniewicz
- Department of Health and Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Raymond Niaura
- Departments of Social and Behavioral Sciences & Epidemiology, School of Global Public Health, New York, NY, USA
| | - Gabriella Anic
- Center for Tobacco Products, Office of Science, Food and Drug Administration, Silver Springs, MD, USA
| | - Yanling Chen
- Center for Tobacco Products, Office of Science, Food and Drug Administration, Silver Springs, MD, USA
| | - Priscilla Callahan-Lyon
- Center for Tobacco Products, Office of Science, Food and Drug Administration, Silver Springs, MD, USA
| | - Lisa D Gardner
- Center for Tobacco Products, Office of Science, Food and Drug Administration, Silver Springs, MD, USA
| | - Theresa Thekkudan
- Center for Tobacco Products, Office of Science, Food and Drug Administration, Silver Springs, MD, USA
| | - Nicolette Borek
- Center for Tobacco Products, Office of Science, Food and Drug Administration, Silver Springs, MD, USA
| | - Heather L Kimmel
- Division of Epidemiology, Services and Prevention Research (DESPR), National Institute on Drug Abuse, Bethesda, MD, USA
| | - K Michael Cummings
- Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Andrew Hyland
- Department of Health and Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Mary Brunette
- Geisel School of Medicine at Dartmouth, The C. Everett Koop Institute at Dartmouth, Lebanon, NH, USA
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29
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Pluta K, Hohl SD, D'Angelo H, Ostroff JS, Shelley D, Asvat Y, Chen LS, Cummings KM, Dahl N, Day AT, Fleisher L, Goldstein AO, Hayes R, Hitsman B, Buckles DH, King AC, Lam CY, Lenhoff K, Levinson AH, Minion M, Presant C, Prochaska JJ, Shoenbill K, Simmons V, Taylor K, Tindle H, Tong E, White JS, Wiseman KP, Warren GW, Baker TB, Rolland B, Fiore MC, Salloum RG. Data envelopment analysis to evaluate the efficiency of tobacco treatment programs in the NCI Moonshot Cancer Center Cessation Initiative. Implement Sci Commun 2023; 4:50. [PMID: 37170381 PMCID: PMC10173908 DOI: 10.1186/s43058-023-00433-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 05/02/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND The Cancer Center Cessation Initiative (C3I) is a National Cancer Institute (NCI) Cancer Moonshot Program that supports NCI-designated cancer centers developing tobacco treatment programs for oncology patients who smoke. C3I-funded centers implement evidence-based programs that offer various smoking cessation treatment components (e.g., counseling, Quitline referrals, access to medications). While evaluation of implementation outcomes in C3I is guided by evaluation of reach and effectiveness (via RE-AIM), little is known about technical efficiency-i.e., how inputs (e.g., program costs, staff time) influence implementation outcomes (e.g., reach, effectiveness). This study demonstrates the application of data envelopment analysis (DEA) as an implementation science tool to evaluate technical efficiency of C3I programs and advance prioritization of implementation resources. METHODS DEA is a linear programming technique widely used in economics and engineering for assessing relative performance of production units. Using data from 16 C3I-funded centers reported in 2020, we applied input-oriented DEA to model technical efficiency (i.e., proportion of observed outcomes to benchmarked outcomes for given input levels). The primary models used the constant returns-to-scale specification and featured cost-per-participant, total full-time equivalent (FTE) effort, and tobacco treatment specialist effort as model inputs and reach and effectiveness (quit rates) as outcomes. RESULTS In the DEA model featuring cost-per-participant (input) and reach/effectiveness (outcomes), average constant returns-to-scale technical efficiency was 25.66 (SD = 24.56). When stratified by program characteristics, technical efficiency was higher among programs in cohort 1 (M = 29.15, SD = 28.65, n = 11) vs. cohort 2 (M = 17.99, SD = 10.16, n = 5), with point-of-care (M = 33.90, SD = 28.63, n = 9) vs. no point-of-care services (M = 15.59, SD = 14.31, n = 7), larger (M = 33.63, SD = 30.38, n = 8) vs. smaller center size (M = 17.70, SD = 15.00, n = 8), and higher (M = 29.65, SD = 30.99, n = 8) vs. lower smoking prevalence (M = 21.67, SD = 17.21, n = 8). CONCLUSION Most C3I programs assessed were technically inefficient relative to the most efficient center benchmark and may be improved by optimizing the use of inputs (e.g., cost-per-participant) relative to program outcomes (e.g., reach, effectiveness). This study demonstrates the appropriateness and feasibility of using DEA to evaluate the relative performance of evidence-based programs.
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Affiliation(s)
- Kathryn Pluta
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, 2004 Mowry Rd, Gainesville, FL, 32610, USA
| | - Sarah D Hohl
- University of Wisconsin Carbone Cancer Center, 600 Highland Ave, Madison, WI, 53705, USA
- School of Medicine and Public Health, University of Wisconsin, 750 Highland Ave, Madison, WI, 53705, USA
| | - Heather D'Angelo
- National Cancer Institute, 9609 Medical Center Dr, Rockville, MD, 20850, USA
| | - Jamie S Ostroff
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Donna Shelley
- New York University School of Global Public Health, 708 Broadway, New York, NY, 10003, USA
| | - Yasmin Asvat
- Rush University Medical Center and Rush Cancer Center, 1725 W Harrison St, Suite 1010, Chicago, IL, 60612, USA
| | - Li-Shiun Chen
- Washington University Siteman Cancer Center, 4921 Parkview Pl, St. Louis, MO, 63110, USA
| | - K Michael Cummings
- Medical University of South Carolina, 171 Ashley Ave, Charleston, SC, 29425, USA
| | - Neely Dahl
- University of Virginia Comprehensive Cancer Center, 1240 Lee St, Charlottesville, VA, 22903, USA
| | - Andrew T Day
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Linda Fleisher
- Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Adam O Goldstein
- University of North Carolina Lineberger Cancer Center, 450 West Dr, Chapel Hill, NC, 27599, USA
| | - Rashelle Hayes
- Virginia Commonwealth University Department of Psychiatry, 501 N 2Nd St, Suite 400B, Richmond, VA, 23219, USA
| | - Brian Hitsman
- Northwestern University Feinberg School of Medicine and Lurie Comprehensive Cancer Center of Northwestern University, 420 E Superior St, Chicago, IL, 60611, USA
| | - Deborah Hudson Buckles
- Indiana University Simon Comprehensive Cancer Center, 535 Barnhill Dr, Indianapolis, IN, USA
| | - Andrea C King
- University of Chicago Medicine Comprehensive Cancer Center, 5758 S Maryland Dr, Chicago, IL, 60637, USA
| | - Cho Y Lam
- Huntsman Cancer Institute, University of Utah, 1950 Circle of Hope Dr, Salt Lake City, UT, 84112, USA
| | - Katie Lenhoff
- One Medical Center Drive, Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, NH, 03756, USA
| | - Arnold H Levinson
- University of Colorado Comprehensive Cancer Center, 1665 North Aurora Court, Aurora, 200480045, USA
| | - Mara Minion
- University of Wisconsin Carbone Cancer Center, 600 Highland Ave, Madison, WI, 53705, USA
| | - Cary Presant
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, 1500 E Duarte Rd, Duarte, CA, 91010, USA
| | - Judith J Prochaska
- Stanford Cancer Institute, Stanford University, 265 Campus Dr, Ste G2103, Stanford, CA, 94305, USA
| | - Kimberly Shoenbill
- University of North Carolina Lineberger Cancer Center, 450 West Dr, Chapel Hill, NC, 27599, USA
| | - Vani Simmons
- H. Lee Moffitt Cancer Center, 3011 Holly Dr, Tampa, FL, 33612, USA
| | - Kathryn Taylor
- Georgetown University Lombardi Comprehensive Cancer Center, 3800 Reservoir Rd NW, Washington, DC, 20007, USA
| | - Hilary Tindle
- Vanderbilt University Medical Center Vanderbilt-Ingram Cancer Center, 2220 Pierce Ave, Nashville, TN, 37232, USA
| | - Elisa Tong
- University of California Davis Comprehensive Cancer Center, 2279 45Th St, Sacramento, CA, 95817, USA
| | - Justin S White
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois St, Floor 7, San Francisco, CA, 94158, USA
| | - Kara P Wiseman
- University of Virginia Comprehensive Cancer Center, 1240 Lee St, Charlottesville, VA, 22903, USA
| | - Graham W Warren
- Medical University of South Carolina, 171 Ashley Ave, Charleston, SC, 29425, USA
| | - Timothy B Baker
- School of Medicine and Public Health, University of Wisconsin, 750 Highland Ave, Madison, WI, 53705, USA
| | - Betsy Rolland
- University of Wisconsin Carbone Cancer Center, 600 Highland Ave, Madison, WI, 53705, USA
- University of Wisconsin Institute for Clinical and Translational Research, 750 Highland Ave, Madison, WI, 53705, USA
| | - Michael C Fiore
- University of Wisconsin Carbone Cancer Center, 600 Highland Ave, Madison, WI, 53705, USA
- School of Medicine and Public Health, University of Wisconsin, 750 Highland Ave, Madison, WI, 53705, USA
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, 2004 Mowry Rd, Gainesville, FL, 32610, USA.
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30
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Freitas-Lemos R, Tegge AN, Athamneh LN, Yeh YH, Craft WH, Stein JS, Smith TT, Stepanov I, Rees VW, Cummings KM, O'Connor RJ, Shields PG, Hatsukami DK, Bickel WK. Is perception reality? Associations among "light" cigarettes and number of cigarettes smoked per day. Drug Alcohol Depend 2023; 244:109709. [PMID: 36642000 PMCID: PMC10081565 DOI: 10.1016/j.drugalcdep.2022.109709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 11/10/2022] [Accepted: 11/10/2022] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Cigarette filter ventilation and light descriptors are associated with lowered perceptions of risk and smoking more cigarettes per day (CPD). This study examined the relationship between usual cigarette ventilation, perception, and CPD. METHODS A crowdsourced sample (N = 995) of individuals who smoke higher-ventilated (=>20% ventilation) or lower-ventilated (=<10% ventilation) cigarettes identified their usual cigarette as "light" or "full flavor", and reported their average CPD. RESULTS We found: 1) no association between ventilation status and perception of light versus full flavor (AUC=0.58), with the inaccurate perception being more prevalent in younger individuals (p = 0.041) and those who smoke L&M (73%, p < 0.001) and Camel (61%, p = 0.006) brands; and 2) perception, but not ventilation of usual cigarette, was significantly associated with CPD (p = 0.006), with individuals who perceived their cigarettes as light reporting an average of 13% more cigarettes per day (2.6 CPD), compared to those who perceived their cigarette as full flavor. CONCLUSIONS Perceptions of light versus full-flavor, but not ventilation status, predicted CPD. These findings may inform anti-smoking health communication strategies and smoking cessation interventions. IMPLICATIONS Tobacco control policies should eradicate the perception of cigarettes as light or full-flavored. Future research investigating the associations between cigarette filter ventilation and smoking behavior should consider the confounding effects that may lie in an individual's perceptions of their cigarettes.
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Affiliation(s)
| | - Allison N Tegge
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA; Department of Statistics, Virginia Tech, Blacksburg, VA, USA
| | - Liqa N Athamneh
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
| | - Yu-Hua Yeh
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
| | - William H Craft
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
| | - Jeffrey S Stein
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
| | - Tracy T Smith
- Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Irina Stepanov
- Division of Environmental Health Sciences, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Vaughan W Rees
- Department of Social and Behavioral Sciences, Harvard University T H Chan School of Public Health, Boston, MA, USA
| | - K Michael Cummings
- Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Peter G Shields
- James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Dorothy K Hatsukami
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Warren K Bickel
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA.
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Gravely S, Chung-Hall J, Craig LV, Fong GT, Cummings KM, Borland R, Yong HH, Loewen R, Martin N, Quah ACK, Hammond D, Ouimet J, Boudreau C, Thompson ME, Driezen P. Evaluating the impact of plain packaging among Canadian smokers: findings from the 2018 and 2020 ITC Smoking and Vaping Surveys. Tob Control 2023; 32:153-162. [PMID: 34548384 PMCID: PMC9330177 DOI: 10.1136/tobaccocontrol-2021-056635] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 06/08/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND In February 2020, Canada implemented plain packaging without any changes to the size and content of health warning labels (HWLs), which were last updated in 2012 (pictorial HWLs on 75% of the pack front and back). This pre-post evaluation study assessed the impact of plain packaging in Canada on: (1) pack appeal; (2) HWL effectiveness; and (3) support for plain packaging. Additionally, a quasi-experimental design was used to assess the Canadian results relative to two comparator countries: Australia, where plain packaging (with new larger HWLs) was implemented in 2012, and the United States (USA), where plain packaging has not been implemented and the same text warnings have appeared on cigarette packs since 1985. METHODS Data are from adult smokers who participated in the 2018 and/or 2020 International Tobacco Control Smoking and Vaping Surveys in Canada (n=4600), Australia (n=1834) and the USA (n=3046). Online surveys were conducted before (February to July 2018) and after (February to June 2020) the implementation of plain packaging in Canada. Adjusted regression analyses were conducted on weighted data. RESULTS Plain packaging was associated with a significant increase in the percentage of Canadian smokers who did not like the look of their cigarette pack (2018: 28.6% vs 2020: 44.7%, p<0.001), whereas no change in pack appeal was observed among smokers in Australia and the USA over the same period. Plain packaging was not associated with changes in HWL effectiveness in Canada. Support for plain packaging increased significantly among Canadian smokers (2018: 25.6% vs 2020: 33.7%, p<0.001). CONCLUSIONS Plain packaging in Canada substantially reduced pack appeal and increased support for the policy among adult smokers; however, there was no increase in the effectiveness of Canada's 8-year-old HWLs. The impact of plain packaging on health warning effectiveness may depend on the design of the warnings and length of time since implementation.
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Affiliation(s)
- Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Janet Chung-Hall
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Lorraine V Craig
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada.,Ontario Institute for Cancer Research, Toronto, Ontario, Canada.,School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - K Michael Cummings
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ron Borland
- School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Hua-Hie Yong
- Department of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Ruth Loewen
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Nadia Martin
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Anne C K Quah
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Janine Ouimet
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Christian Boudreau
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Mary E Thompson
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada.,School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Stanton CA, Tang Z, Sharma E, Seaman E, Gardner LD, Silveira ML, Hatsukami D, Day HR, Cummings KM, Goniewicz ML, Limpert J, Everard C, Bansal-Travers M, Ambrose B, Kimmel HL, Borek N, Compton WM, Hyland AJ, Pearson JL. Predictors of E-cigarette and Cigarette Use Trajectory Classes from Early Adolescence to Emerging Adulthood Across Four Years (2013-2017) of the PATH Study. Nicotine Tob Res 2023; 25:421-429. [PMID: 35554569 PMCID: PMC9910140 DOI: 10.1093/ntr/ntac119] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 02/10/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION This study examines predictors of trajectories of cigarette and e-cigarette use among a cohort of US adolescents transitioning into young adulthood. Comparing trajectories of each tobacco product is important to determine if different intervention targets are needed to prevent progression to daily use. METHODS Latent trajectory class analyses identified cigarette and e-cigarette use (never, ever excluding past 12-month, past 12-month (excluding past 30-day (P30D)), P30D 1-5 days, P30D 6+ days) trajectory classes, separately, among US youth (12-17; N = 10,086) using the first 4 waves (2013-2017) of data from the nationally representative PATH Study. Weighted descriptive analyses described the class characteristics. Weighted multinomial logistic regression analyses examined demographic, psychosocial, and behavioral predictors of class membership. RESULTS Younger adolescents 12-15 years had lower tobacco use compared to 16-17 year olds and less stable classes. In the 16-17 year group, there were five unique trajectories of cigarette smoking, including a Persistent High Frequency class. Four e-cigarette use trajectories were identified; but not a persistent use class. Shared predictors of class membership for cigarettes and e-cigarettes included mental health problems, other tobacco use, marijuana use, and poorer academic achievement. Male sex and household tobacco use were unique e-cigarette trajectory class predictors. CONCLUSIONS There was no evidence that initiation with e-cigarettes as the first product tried was associated with cigarette progression (nor cigarettes as first product and e-cigarette progression). Interventions should focus on well-established risk factors such as mental health and other substance use to prevent progression of use for both tobacco products. IMPLICATIONS Using nationally representative data and definitions of use that take into account frequency and recency of use, longitudinal 4-year trajectories of e-cigarette and cigarette use among US adolescents transitioning into young adulthood were identified. Results among 16-17-year olds revealed a class of persistent high frequency cigarette smoking that was not identified for e-cigarette use. Cigarette use progression was not associated with e-cigarettes as the first product tried. Risk factors for progression of use of both products included mental health and other substance use, which are important prevention targets for both tobacco products.
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Affiliation(s)
- Cassandra A Stanton
- Behavioral Health and Health Policy Practice, Westat Inc, Rockville, MD, USA
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA
| | - Zhiqun Tang
- Behavioral Health and Health Policy Practice, Westat Inc, Rockville, MD, USA
| | - Eva Sharma
- Behavioral Health and Health Policy Practice, Westat Inc, Rockville, MD, USA
| | - Elizabeth Seaman
- Behavioral Health and Health Policy Practice, Westat Inc, Rockville, MD, USA
| | - Lisa D Gardner
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Marushka L Silveira
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
- Kelly Government Solutions, Rockville, MD, USA
| | - Dorothy Hatsukami
- Masonic Cancer Center, Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Hannah R Day
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - K Michael Cummings
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Maciej L Goniewicz
- Department of Health Behavior, Division of Cancer Prevention & Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Jean Limpert
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Colm Everard
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
- Kelly Government Solutions, Rockville, MD, USA
| | - Maansi Bansal-Travers
- Department of Health Behavior, Division of Cancer Prevention & Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Bridget Ambrose
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Heather L Kimmel
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
| | - Nicolette Borek
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Wilson M Compton
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
| | - Andrew J Hyland
- Department of Health Behavior, Division of Cancer Prevention & Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Jennifer L Pearson
- School of Community Health Sciences, University of Nevada, Reno, Reno, NV, USA
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Strong DR, Pierce JP, White M, Stone MD, Abrams DB, Glasser AM, Wackowski OA, Cummings KM, Hyland A, Taylor K, Edwards KC, Silveira ML, Kimmel HL, Lambert EY, Compton WM, Hull LC, Niaura R. RETRACTED: Changes in Tobacco Dependence and Association With Onset and Progression of Use by Product Type From Wave 1 to Wave 3 of the Population Assessment of Tobacco and Health (PATH) Study. Nicotine Tob Res 2023; 25:571-579. [PMID: 35801819 DOI: 10.1093/ntr/ntac167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 06/13/2022] [Accepted: 07/06/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION This study examined trajectories of tobacco dependence (TD) in relation to changes in tobacco product use and explored the effects of product-specific adding, switching, or discontinued use on dependence over time. AIMS AND METHODS Data were analyzed from the first three waves of the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative, longitudinal study of adults and youth in the United States. Data included 9556 Wave 1 (2013/2014) adult current established tobacco users who completed all three interviews and had established use at ≥2 assessments. Groups included cigarettes-only users, e-cigarettes-only users, cigars-only users, hookah-only users, any smokeless-only users, cigarette + e-cigarette dual users, and multiple product users. A validated 16-item scale assessed TD across product users. RESULTS Wave 1 e-cigarette-only users' who maintained exclusive e-cigarette use increased levels of TD through Wave 3 as did those who added or switched to another product. Wave 1 multiple product users' TD decreased across waves. TD for all other Wave 1 user groups remained about the same. For Wave 1 cigarette-only smokers, switching to another product or moving to a pattern of no established use was associated with lower levels of TD than smokers whose use stayed the same. Movement to no established use of any tobacco product was consistently associated with lower TD for all other product users. CONCLUSIONS Except for Wave 1 e-cigarette-only users, TD among US tobacco product users was stable over time, with daily users less likely to vary from baseline. IMPLICATIONS The level of TD among most US tobacco users was stable over the first three waves of the PATH Study and trends in levels of TD were predominantly unrelated to changes in patterns of continued product use. Stable levels of TD suggest a population at persistent risk of health impacts from tobacco. Wave 1 e-cigarette users, including those maintaining exclusive e-cigarette use, experienced increasing levels of TD over time, perhaps because of increases in quantity or frequency of their e-cigarette product use or increasing efficiency of nicotine delivery over time.
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Affiliation(s)
- David R Strong
- Cancer Prevention and Control Program, Moores Cancer Center University of California, San Diego, CA, USA.,Herbert Wertheim School of Public Health, University of California, San Diego, CA, USA
| | - John P Pierce
- Herbert Wertheim School of Public Health, University of California, San Diego, CA, USA
| | - Martha White
- Cancer Prevention and Control Program, Moores Cancer Center University of California, San Diego, CA, USA.,Herbert Wertheim School of Public Health, University of California, San Diego, CA, USA
| | - Matthew D Stone
- Herbert Wertheim School of Public Health, University of California, San Diego, CA, USA
| | - David B Abrams
- School of Global Public Health, New York University, New York, NY, USA
| | - Allison M Glasser
- School of Global Public Health, New York University, New York, NY, USA
| | - Olivia A Wackowski
- Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, NJ, USA
| | | | | | | | | | - Marushka L Silveira
- National Institute on Drug Abuse (NIDA/NIH), Bethesda, MD, USA.,Kelly Government Solutions, Rockville, MD, USA
| | | | | | | | - Lynn C Hull
- Center for Tobacco Products, FDA, Silver Spring, MD, USA
| | - Raymond Niaura
- School of Global Public Health, New York University, New York, NY, USA
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Kasza KA, Hammond D, Gravely S, O'Connor RJ, Meng G, East K, Borland R, Cummings KM, Fong GT, Hyland A. Associations between nicotine vaping uptake and cigarette smoking cessation vary by smokers' plans to quit: longitudinal findings from the International Tobacco Control Four Country Smoking and Vaping Surveys. Addiction 2023; 118:340-352. [PMID: 36110040 PMCID: PMC9812858 DOI: 10.1111/add.16050] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 09/06/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIMS Most population studies that evaluate the relationship between nicotine vaping and cigarette cessation focus on limited segments of the smoker population. We evaluated vaping uptake and smoking cessation considering differences in smokers' plans to quit. DESIGN Longitudinal International Tobacco Control (ITC) Four Country Smoking and Vaping Surveys were conducted in 2016, 2018 and 2020. SETTING This study was conducted in the United States, Canada, England and Australia. PARTICIPANTS Participants of this study were adult daily cigarette smokers who had not vaped in the past 6 months at baseline and had participated in two or more consecutive waves of the ITC Four Country Smoking and Vaping Surveys (n = 2815). MEASUREMENTS Plans to quit cigarette smoking was assessed at baseline (within 6 months, beyond 6 months, not planning to quit) and at follow-up (within 6 months vs not within 6 months), cigarette smoking cessation was assessed at follow-up (smoking less than monthly [including complete cessation] vs daily/weekly/monthly smoking) and inter-wave vaping uptake was assesed between baseline and follow-up (none, only non-daily vaping and any daily vaping). Generalized estimating equations were used to evaluate whether inter-wave vaping uptake was associated with smoking cessation at follow-up and with planning to quit at follow-up, each stratified by plans to quit smoking at baseline. FINDINGS Overall, 12.7% of smokers quit smoking. Smokers not initially planning to quit within 6 months experienced higher odds of smoking cessation when they took up daily vaping (32.4%) versus no vaping (6.8%; adjusted odds ratio [AOR], 8.58; 95% CI, 5.06-14.54). Among smokers planning to quit, smoking cessation rates were similar between those who did and did not take up daily vaping (25.1% vs 16.8%; AOR, 1.91; 95% CI, 0.91-4.00), although we could not account for potential use of cessation aids. Daily vaping uptake was associated with planning to quit smoking at follow-up among those initially not planning to quit (AOR,6.32; 95% CI, 4.17-9.59). CONCLUSIONS Uptake of nicotine vaping appears to be strongly associated with cigarette smoking cessation among smokers with no initial plans to quit smoking. Excluding smokers not planning to quit from studies on vaping and smoking cessation may underestimate potential benefit of daily vaping for daily smokers.
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Affiliation(s)
- Karin A Kasza
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Gang Meng
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
| | - Katherine East
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ron Borland
- Melbourne Centre for Behaviour Change, School of Psychological Sciences, University of Melbourne, Parkville, Australia
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Geoffrey T Fong
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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Klemperer EM, Bunn JY, Palmer AM, Smith TT, Toll BA, Cummings KM, Carpenter MJ. E-cigarette cessation and transitions in combusted tobacco smoking status: longitudinal findings from the US FDA PATH Study. Addiction 2023; 118:1161-1166. [PMID: 36710461 PMCID: PMC10175178 DOI: 10.1111/add.16141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 01/12/2023] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND AIMS Electronic nicotine delivery systems (ENDS) can help people to quit smoking combusted tobacco products (CTPs), but most current and former smokers who use ENDS also intend to quit ENDS. This analysis measured whether ENDS cessation among current and former CTP smokers is associated with changes in CTP smoking or abstinence. DESIGN Regression analysis of a nationally representative cohort from waves 4 (W4) and 5 (W5) of the Population Assessment of Tobacco and Health Study (December 2016-November 2019). SETTING United States. PARTICIPANTS Adults (n = 1525) who reported W4 current or former use of ≥ 1 CTP and either currently using ENDS or quitting ENDS in the past year were included. MEASUREMENTS Logistic regressions were performed separately among W4 current and former CTP smokers, controlling for demographic and tobacco use characteristics. First, we analyzed proximal outcomes by testing the association between ENDS quit status and CTP abstinence, both occurring during W5. Next, we analyzed long-term outcomes by testing W4 ENDS quit status as a predictor of CTP abstinence at W5, approximately 1 year later. FINDINGS Among W4 current CTP smokers, there was no evidence that CTP smoking abstinence differed between those quitting or continuing using ENDS, both in our proximal [adjusted odds ratio (aOR) = 1.37, 95% confidence interval (CI) = 0.90, 2.10] and long-term (aOR = 0.90, 95% CI = 0.52, 1.53) analyses. Among former CTP smokers, quitting ENDS was associated with less CTP abstinence in our proximal analysis (aOR = 0.42, 95% CI = 0.20, 0.89), but there was no evidence that CTP smoking abstinence differed between those quitting or continuing using ENDS in our long-term analysis (aOR = 0.86, 95% CI = 0.44, 1.67). CONCLUSIONS There is no evidence that ENDS cessation is associated with CTP abstinence among current smokers, although mixed findings among former smokers indicate a possible risk for relapse to smoking associated with quitting ENDS.
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Affiliation(s)
- Elias M Klemperer
- Department of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, USA
| | - Janice Y Bunn
- Department of Biostatistics, University of Vermont, Burlington, VT, USA
| | - Amanda M Palmer
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA.,Department of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Tracy T Smith
- Department of Psychiatry and Behavioral Sciences and Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Benjamin A Toll
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA.,Department of Psychiatry and Behavioral Sciences and Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences and Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Matthew J Carpenter
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA.,Department of Psychiatry and Behavioral Sciences and Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
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36
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Li L, Borland R, Cummings KM, Hyland A, Le Grande M, Fong GT, McNeill A. Non-cigarette combustible tobacco use and its associations with subsequent cessation of smoking among daily cigarette smokers: findings from the International Tobacco Control Four Country Smoking and Vaping Surveys (2016-20). Addiction 2023; 118:140-148. [PMID: 35938219 DOI: 10.1111/add.16023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 07/26/2022] [Indexed: 11/29/2022]
Abstract
AIMS To examine whether polyuse of cigarettes and other smoked products (polysmoking) is predictive of quit attempts and quit success. DESIGN A prospective multi-country cohort design. SETTING Australia, Canada, England and the United States. PARTICIPANTS A total of 3983 adult daily cigarette smokers were surveyed in 2016 (wave 1 of data collection) and were re-contacted in 2018 (wave 2) (i.e. waves 1-2 cohort) in the International Tobacco Control Four Country Smoking and Vaping (ITC 4CV) surveys; and 3736 smokers were surveyed in 2018 and re-contacted in 2020 (wave 3) (i.e. waves 2-3 cohort). MEASUREMENTS Participants were asked about their cigarette smoking and use of cigars, cigarillos, pipes and waterpipes. Outcomes were quit attempts between two survey waves and success, defined as having quit smoking all the combustible tobacco at the subsequent survey for 1 month or more. FINDINGS Levels of polysmoking were 12.7% in the waves 1-2 cohort and 10.5% for the waves 2-3 cohort. Compared with cigarette-only smokers, polysmokers were more likely to attempt to quit between waves 1 and 2 [54.9 versus 42.7%, adjusted odds ratio (aOR) = 1.37, 95% confidence interval (CI) = 1.08-1.74, P < 0.01], but not between waves 2 and 3 (43.8 versus 40.1%, aOR = 0.94, 95% CI = 0.72-1.22). Polysmoking predicted reduced likelihood of success in both cohorts among attempters and the overall samples. Between waves 2 and 3 there were significantly more transitions to non-daily smoking among the polysmokers (12.4 versus 5.3%, χ2 = 40.4, P < 0.001). CONCLUSIONS There is a consistent association between polysmoking (use of cigarettes together with other smoked products) and reduced quit success for combustible tobacco, but it is probably due to increased likelihood of transitioning to non-daily use rather than complete cessation.
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Affiliation(s)
- Lin Li
- Melbourne Centre for Behaviour Change, School of Psychological Sciences, University of Melbourne Parkville Campus, Parkville, VIC, Australia
| | - Ron Borland
- Melbourne Centre for Behaviour Change, School of Psychological Sciences, University of Melbourne Parkville Campus, Parkville, VIC, Australia
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Michael Le Grande
- Melbourne Centre for Behaviour Change, School of Psychological Sciences, University of Melbourne Parkville Campus, Parkville, VIC, Australia
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada.,School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.,Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Ann McNeill
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Shaping Public hEalth poliCies To Reduce ineqUalities and harm (SPECTRUM), London, UK
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Cheng KW, Liu F, Pesko MF, Levy DT, Fong GT, Cummings KM. Impact of vaping restrictions in public places on smoking and vaping in the United States-evidence using a difference-in-differences approach. Addiction 2023; 118:160-166. [PMID: 36043346 PMCID: PMC9722614 DOI: 10.1111/add.16039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 08/17/2022] [Indexed: 11/28/2022]
Abstract
AIMS To estimate whether and to what extent extending indoor smoking restrictions to include electronic cigarettes (ECs) impact the use of ECs and cigarette smoking among adults in the United States. DESIGN Observational study using a linear probability model and applying a difference-in-differences analysis. SETTING United States. PARTICIPANTS People aged 18-54 who lived in US counties where comprehensive indoor smoking laws in bars, restaurants and private work-places have been in place prior to 2010 (n = 45 111 for EC use analysis, n = 75 959 for cigarette use analysis). MEASUREMENTS Data on cigarette smoking, use of ECs and place of residence from the Tobacco Use Supplement of the Current Population Survey (TUS-CPS 2010-11, 2014-15 and 2018-19) were combined with the American Nonsmokers' Rights Foundation (ANRF) database of state and local indoor smoking and vaping restriction laws. FINDINGS Indoor vaping restriction (IVR) coverage was not significantly associated with the likelihood of adult EC use [coefficient estimate = 0.001; 95% confidence interval (CI) = -0.009, 0.013, P-value = 0.783]. In addition, IVR coverage was not significantly associated with adult cigarette smoking (coefficient estimate = -0.00; 95% CI = -0.016, 0.015, P-value = 0.954). The non-significant results appeared in different socio-demographic subgroups. CONCLUSIONS IVRs do not appear to decrease electronic cigarette use among US adults. There is no evidence that IVRs increase or decrease cigarette smoking among US adults.
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Affiliation(s)
- Kai-Wen Cheng
- Department of Health Administration, Governors State University, University Park, IL, USA
| | - Feng Liu
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, China
| | - Michael F Pesko
- Department of Economics, Georgia State University, Atlanta, GA, USA
| | - David T Levy
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
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Pesko MF, Cummings KM, Douglas CE, Foulds J, Miller T, Rigotti NA, Warner KE. United States public health officials need to correct e-cigarette health misinformation. Addiction 2022; 118:785-788. [PMID: 36507802 DOI: 10.1111/add.16097] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/09/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Michael F Pesko
- Department of Economics, Andrew Young School of Policy Studies, Georgia State University, Atlanta, GA, USA
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Clifford E Douglas
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Jonathan Foulds
- Department of Public Health Sciences, Penn State University - College of Medicine, Hershey, PA, USA
| | | | - Nancy A Rigotti
- Department of Medicine, Harvard Medical School, Boston, MA, USA.,Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, USA
| | - Kenneth E Warner
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
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Gravely S, Driezen P, McClure EA, Hammond D, Michael Cummings K, Chan G, Hyland A, Borland R, East KA, Fong GT, Schauer GL, Quah ACK, Ouimet J, Smith DM. Differences between adults who smoke cigarettes daily and do and do not co-use cannabis: Findings from the 2020 ITC four country smoking and vaping survey. Addict Behav 2022; 135:107434. [PMID: 35908323 DOI: 10.1016/j.addbeh.2022.107434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/28/2022] [Accepted: 07/19/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Little is known about population-level differences between adults who exclusively smoke cigarettes and those who smoke cigarettes and also use cannabis (co-consumers). Thus, this study describes differences on sociodemographic, cigarette-dependence, health and behavioral variables, and risk perceptions associated with smoking cannabis. METHODS This cross-sectional study included 6941 respondents from the 2020 ITC Four Country Smoking and Vaping Survey (US, Canada, Australia, England). Adult daily cigarette smokers were included and categorized as: cigarette-only smokers (never used cannabis/previously used cannabis, but not in the past 12 months, n = 4857); occasional co-consumers (cannabis use in the past 12 months, but < weekly use, n = 739); or regular co-consumers (use cannabis ≥ weekly, n = 1345). All outcomes were self-reported. Regression models were conducted on weighted data. RESULTS Overall, 19.9 % of respondents reported regular cannabis co-use and 10.1 % reported occasional co-use. Regular co-use was highest in Canada (27.2 %), followed by the US (24.4 %), England (12.7 %) and Australia (12.3 %). Compared to cigarette-only smokers, regular co-consumers were more likely to be male and report chest/breathing problems (p < 0.001). All co-consumers were more likely to be younger, have lower income, be experiencing financial stress, reside in Canada, have depressive symptoms, use alcohol more frequently and binge drink, use other tobacco/nicotine products, and perceive smoking cannabis as low health risk and less harmful than smoking cigarettes (all p < 0.001). Cigarette dependence measures were similar between co-consumers and cigarette-only smokers (all p ≥ 0.05). CONCLUSIONS Although there were no differences on cigarette dependence measures between daily cigarette smokers who do and do not use cannabis, there are several other risk factors that may affect tobacco use and abstinence among co-consumers (e.g., greater depression, high-risk alcohol consumption). Thus, tobacco cessation treatment may require multi-pronged strategies to address other health behaviors. Continued surveillance is needed to determine the nature and health implications of co-use considering changing policies, markets, and products.
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Affiliation(s)
| | | | - Erin A McClure
- Medical University of South Carolina (MUSC), Hollings Cancer Center, USA
| | | | - K Michael Cummings
- Medical University of South Carolina (MUSC), Hollings Cancer Center, USA
| | - Gary Chan
- National Centre for Youth Substance Use Research, The University of Queensland, Australia
| | | | | | | | - Geoffrey T Fong
- University of Waterloo, Canada; Ontario Institute for Cancer Research, Toronto, Ontario, Canada
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40
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Gravely S, Meng G, Hammond D, Reid JL, Seo YS, Hyland A, Cummings KM, Rivard C, Fong GT, Kasza KA. Electronic nicotine delivery systems (ENDS) flavours and devices used by adults before and after the 2020 US FDA ENDS enforcement priority: findings from the 2018 and 2020 US ITC Smoking and Vaping Surveys. Tob Control 2022; 31:s167-s175. [PMID: 36328466 PMCID: PMC9641531 DOI: 10.1136/tobaccocontrol-2022-057445] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/17/2022] [Indexed: 11/22/2022]
Abstract
Background In February 2020, the US Food and Drug Administration (FDA) prioritised enforcement efforts against flavoured prefilled cartridge/pod electronic nicotine delivery systems (ENDS), with the exception of tobacco and menthol. This study examined changes between prepriority enforcement (2018) and early postenforcement (February–June 2020) among adults on: ENDS flavours and devices used most often; location of last purchase of fruit/other-flavoured cartridges (covered under the enforcement priority); and smoking and vaping. Methods Prevalence estimates came from 1608 adult frequent (≥weekly) ENDS users (current smokers (n=1072), ex-smokers (n=536)) who participated in the 2018 and/or 2020 US ITC Smoking and Vaping Surveys. Transitions between flavours/devices and changes in smoking/vaping were assessed among baseline respondents who were followed up in 2020 (n=360). Respondents self-reported the ENDS device (disposable, cartridge/pod or tank) and the flavor that they used most often: (1) tobacco flavors (tobacco/tobacco-menthol mix) or unflavored; (2) menthol/mint; (3) fruit/other flavors. Results Compared to 2018, in the first 5 months of the 2020 enforcement priority, there were significant increases in the prevalence of fruit/other-flavoured cartridges (7.9% to 12.4%,p=0.026) and menthol/mint cartridges (7.1% to 13.0%, p<0.01) and decreases in tobacco-flavoured tanks (15.5% to 10.0%,p=0.002) and fruit/other-flavoured tanks (38.7% to 33.6%,p=0.038). Fewer than 10% of adults used disposables in 2018 and 2020. Among the cohort sample, the most pronounced transitions between flavours/devices occurred among those who used flavoured cartridges covered under the enforcement priority (54.6% switched to a flavour and/or device excluded from enforcement). There was an increase in purchasing fruit/other-flavoured cartridges online and a decrease in retail locations except for vape shops. Overall, there were few changes in smoking and vaping behaviours. Conclusions Between 2018 and the early phase of the FDA’s 2020 enforcement priority, prevalence of menthol/mint and fruit/other-flavoured cartridges increased among adults. Half of vapers using cartridge flavours covered in the enforcement switched to other flavours and/or devices that were exempt, with the exception of disposables. The extent to which more comprehensive restrictions may be problematic for adults who prefer a range of ENDS flavours remains uncertain.
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Affiliation(s)
- Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Gang Meng
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Jessica L Reid
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Young S Seo
- Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Andrew Hyland
- Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - K Michael Cummings
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Cheryl Rivard
- Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada,School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada,Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Karin A Kasza
- Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
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Freitas-Lemos R, Stein JS, Tegge AN, Kaplan BA, Heckman BW, McNeill A, Cummings KM, Fong GT, Bickel WK. Illegal Experimental Tobacco Marketplace II: effects of vaping product bans - findings from the 2020 International Tobacco Control Project. Tob Control 2022; 31:s214-s222. [PMID: 36328461 PMCID: PMC9664097 DOI: 10.1136/tc-2022-057515] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/04/2022] [Indexed: 11/16/2022]
Abstract
SIGNIFICANCE Restrictive e-cigarette policies may increase purchases from illegal sources. The Illegal Experimental Tobacco Marketplace (IETM) allows examination of how restrictions impact illegal purchases. We investigated (1) the effect of a vaping ban, total flavour vaping ban and partial flavour vaping ban on the probability of purchasing illegal vaping products among different regulatory environments (USA, Canada and England) and tobacco user types (cigarette smokers, dual users and e-cigarette users); and (2) the relation between ban endorsement and illegal purchases. METHODS Participants (N=459) from the International Tobacco Control Survey rated their support of bans and chose to purchase from a hypothetical legal experimental tobacco marketplace or IETM under control and the three ban conditions. RESULTS In total, 25% of cigarette smokers, 67% of dual users and 79% of e-cigarette users made IETM purchases. Cross-country comparisons depicted dual users from Canada (OR: 19.8), and e-cigarette users from the USA (OR: 12.9) exhibited higher illegal purchases odds than the same user type in England. Within-country comparisons showed e-cigarette and dual users are more likely to purchase from the IETM than cigarette smokers in the most restrictive condition, with the largest effects in e-cigarette users (England-OR: 1722.6, USA-OR: 22725.3, Canada-OR: 6125.0). Increased opposition towards partial or total flavour ban was associated with increased IETM purchasing in the corresponding condition. CONCLUSIONS Vaping restrictions may shift users' preference to the illegal marketplace in a regulatory environment. Evidence of the IETM generalisability in a geographically dispersed sample enhances its utility in tobacco regulatory science.
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Affiliation(s)
| | - Jeffrey S Stein
- Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA
| | - Allison N Tegge
- Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA
| | - Brent A Kaplan
- Department of Family and Community Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Bryan W Heckman
- Center for the Study of Social Determinants on Health, Meharry Medical College, Nashville, Tennessee, USA
| | - Ann McNeill
- UK Centre for Tobacco Control Studies, National Addiction Centre, Institute of Psychiatry, King's College London, London, UK
| | - K Michael Cummings
- Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada.,Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Warren K Bickel
- Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA
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Cooper M, Day HR, Ren C, Oniyide O, Corey CG, Ambrose BK, Michael Cummings K, Sargent J, Niaura R, Pierce JP, Kaufman A, Choi K, Goniewicz ML, Stanton CA, Villanti A, Kasza K, Bansal-Travers M, Silveira ML, Kimmel HL, Hull LC, Koblitz A, Poonai K, Paredes A, Taylor K, Borek N, Hyland AJ. Correlates of tobacco product initiation among youth and young adults between waves 1-4 of the population assessment of tobacco and Health (PATH) study (2013-2018). Addict Behav 2022; 134:107396. [PMID: 35749867 PMCID: PMC9726988 DOI: 10.1016/j.addbeh.2022.107396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 05/13/2022] [Accepted: 06/05/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION While risk factors for cigarette smoking among youth and young adults are well-documented, less is known about the correlates of initiation of other tobacco products. This study aims to provide estimates and correlates of initiation among U.S. youth and young adults. METHODS Data on youth aged 12-17 (n = 10,072) and young adults aged 18-24 (N = 5,727) who provided information on cigarettes, electronic nicotine delivery systems (ENDS), cigars, pipe, hookah and smokeless tobacco use in Wave 1 (W1: 2013-2014)-Wave 4 (W4: 2016-2018) of the nationally-representative PATH Study were used to calculate ever use initiation and correlates of initiation by W4. RESULTS Nearly 6 million youth and 2.5 million young adults used tobacco for the first time between W1-W4. Approximately one quarter of youth and young adult ENDS never users initiated ENDS between W1-W4 of the PATH Study. Among youth, use of other tobacco products, ever substance use, and high externalizing problems were associated with initiation of most products. Among young adults, use of other tobacco products and ever substance use were associated with initiation of most products. In both youth and young adults, Hispanics were more likely to initiate hookah use than their non-Hispanic White counterparts. While male sex was a risk factor for most tobacco product initiation across both age groups, it was not associated with hookah initiation. CONCLUSIONS Cigarette and non-cigarette products shared many correlates of initiation, although there are noteworthy demographic differences. Findings can help tailor product specific interventions to reach populations at risk during preliminary stages of use.
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Affiliation(s)
- Maria Cooper
- US Food and Drug Administration, Center for Tobacco Products, United States.
| | - Hannah R Day
- US Food and Drug Administration, Center for Tobacco Products, United States
| | - Chunfeng Ren
- US Food and Drug Administration, Center for Tobacco Products, United States
| | - Olusola Oniyide
- US Food and Drug Administration, Center for Tobacco Products, United States
| | - Catherine G Corey
- US Food and Drug Administration, Center for Tobacco Products, United States
| | - Bridget K Ambrose
- US Food and Drug Administration, Center for Tobacco Products, United States
| | - K Michael Cummings
- Medical University of South Carolina, Department of Psychiatry & Behavioral Sciences, United States
| | - James Sargent
- Dartmouth Medical School, Data Sciences Norris Cotton Cancer Center Dartmouth-Hitchcock Medical Center, United States
| | - Ray Niaura
- New York University, College of Global Public Health, United States
| | - John P Pierce
- University of California, San Diego, Herbert Wertheim School of Public Health, United States
| | - Annette Kaufman
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, United States
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, United States
| | | | | | | | - Karin Kasza
- Roswell Park Comprehensive Cancer Center, United States
| | | | - Marushka L Silveira
- Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse, National Institutes of Health, United States; Kelly Government Solutions, United States
| | - Heather L Kimmel
- Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse, National Institutes of Health, United States
| | - Lynn C Hull
- US Food and Drug Administration, Center for Tobacco Products, United States
| | - Amber Koblitz
- US Food and Drug Administration, Center for Tobacco Products, United States
| | - Karl Poonai
- US Food and Drug Administration, Center for Tobacco Products, United States
| | - Antonio Paredes
- US Food and Drug Administration, Center for Tobacco Products, United States
| | - Kristie Taylor
- Westat, Behavioral Health and Health Policy, United States
| | - Nicolette Borek
- US Food and Drug Administration, Center for Tobacco Products, United States
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Cho YJ, Thrasher JF, Gravely S, Alberg A, Borland R, Yong HH, Cummings KM, Hitchman SC, Fong GT. Adult smokers' discussions about vaping with health professionals and subsequent behavior change: a cohort study. Addiction 2022; 117:2933-2942. [PMID: 35792058 PMCID: PMC10964167 DOI: 10.1111/add.15994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 06/07/2022] [Indexed: 11/27/2022]
Abstract
AIMS To measure the prevalence and changes in smokers' discussions with health professionals (HPs) about nicotine vaping products (NVPs) and HPs' recommendations about NVPs between 2016 and 2020, and their associations with tobacco product use transitions. DESIGN Cohort study using multinomial logistic regression analyses on data from waves 1 (2016), 2 (2018) and 3 (2020) from the International Tobacco Control Four Country Smoking and Vaping Surveys. SETTING Four countries with varying NVP regulatory environments: 'most restrictive' (Australia), 'somewhat restrictive' (Canada) and 'less restrictive' (England and the United States). PARTICIPANTS Adult exclusive daily smokers who did not report NVP use at the time of their baseline survey and had visited a HP in the last 12-24 months. Prevalence data came from 4125, 4503 and 4277 respondents, respectively, for each year. Longitudinal data were from 4859 respondents who participated in at least two consecutive surveys. MEASUREMENTS Prevalence of self-reported discussions with HPs and recommendations from HPs about NVPs. Longitudinal transitions from smoking to vaping (either exclusively or concurrently with smoking) and quitting (regardless of NVP uptake). FINDINGS The prevalence of NVP discussions was low among countries with varying regulatory environments and study waves (range = 1.4-6.2%). In 2020, a low percentage of smokers who discussed NVPs with a HP reported that their HPs recommended they use NVPs in the United States (14.7%), Australia (20.2%), Canada (25.7%), with a higher percentage in England (55.7%) where clinical guidelines for smoking cessation include NVPs. Compared with 12.0% of smokers who reported no discussion, 37.0% of those whose HPs recommended NVPs transitioned to vaping at follow-up. Transition to quitting was 9.6% with HPs' recommendation of NVPs versus 13.5% without discussion, a non-significant difference. CONCLUSIONS In Australia, Canada, England and the United States between 2016 and 2020, health professionals' discussions with smokers about nicotine vaping products (NVPs) were infrequent. NVP discussions were associated with NVP uptake, but not with quitting smoking.
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Affiliation(s)
- Yoo Jin Cho
- Department of Internal Medicine, Ohio State University, Columbus, OH, USA
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
| | - Anthony Alberg
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Ron Borland
- Cancer Council Victoria, Melbourne, VIC, Australia
- School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Hua-Hie Yong
- School of Psychology, Deakin University, Geelong, VIC, Australia
| | - K Michael Cummings
- Department of Psychiatry and Behavioural Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Sara C Hitchman
- Department of Communication and Media Research, University of Zurich, Zürich, Switzerland
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
- Department of Communication and Media Research, University of Zurich, Zürich, Switzerland
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
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Gravely S, Yong HH, Reid JL, East KA, Gartner CE, Levy DT, Cummings KM, Borland R, Quah ACK, Bansal-Travers M, Ouimet J, Fong GT. Do Current Smokers and Ex-Smokers Who Use Nicotine Vaping Products Daily Versus Weekly Differ on Their Reasons for Vaping? Findings from the 2020 ITC Four Country Smoking and Vaping Survey. Int J Environ Res Public Health 2022; 19:ijerph192114130. [PMID: 36361015 PMCID: PMC9653847 DOI: 10.3390/ijerph192114130] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 05/31/2023]
Abstract
This study examined reasons why adults who currently smoke or formerly smoked cigarettes use nicotine vaping products (NVPs) by vaping frequency (daily vs. weekly) stratified by smoking status. This cross-sectional study included 3070 adults from the 2020 ITC Four Country Smoking and Vaping Survey (Australia, Canada, England, United States) who reported using a NVP (vaping) at least weekly and who either currently smoke (n = 2467) or formerly smoked (n = 603). Respondents were asked to select the reason(s) they use NVPs, including to manage their smoking (reduce/quit or remain quit) and/or for reasons unrelated to managing smoking (e.g., to save money, enjoyment, flavours). We found that both current and former smokers endorsed an average of six reasons for vaping, with those vaping daily reporting significantly more reasons than those vaping weekly. Among current smokers, 72.8% reported vaping may help them quit smoking, 13.0% reported vaping to reduce smoking but not to quit, and 14.2% reported vaping only for reasons other than to reduce or quit smoking. The most common reason for vaping among current smokers was to reduce smoking (81.3%). Current smokers vaping daily were significantly more likely than those vaping weekly to report using a NVP to reduce smoking, for enjoyment, to reduce harm to themselves and others, to quit smoking, likeable flavours, and to save money. The most common reason cited for vaping by respondents who formerly smoked was enjoyment, with those who vaped daily more likely than those who vaped weekly to report vaping for enjoyment and to reduce harm to themselves. Nearly all reported vaping to help stay abstinent from smoking (92.3%), with no significant difference by vaping frequency. In conclusion, a majority of respondents reported using NVPs to manage their smoking (reduce/quit smoking or remain quit), particularly those vaping daily. Those who were vaping daily also endorsed a greater number of reasons other than managing smoking relative to those who were vaping weekly.
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Affiliation(s)
- Shannon Gravely
- Department of Psychology, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada
| | - Hua-Hie Yong
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC 3220, Australia
| | - Jessica L. Reid
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada
| | - Katherine A. East
- Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, Addictions Sciences Building, 4 Windsor Walk, Denmark Hill, London SE5 8BB, UK
| | - Coral E. Gartner
- School of Public Health, Faculty of Medicine, The University of Queensland, The Public Health Building, Corner of Wyndham St and Herston Road, Herston, QLD 4006, Australia
| | - David T. Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, 3800 Reservoir Rd NW, Washington, DC 20007, USA
| | - K. Michael Cummings
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, 67 President St., Charleston, SC 29425, USA
| | - Ron Borland
- School of Psychological Sciences, University of Melbourne, Grattan Street, Parkville, VIC 3010, Australia
| | - Anne C. K. Quah
- Department of Psychology, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada
| | - Maansi Bansal-Travers
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263, USA
| | - Janine Ouimet
- Department of Psychology, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada
| | - Geoffrey T. Fong
- Department of Psychology, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada
- Ontario Institute for Cancer Research, 661 University Ave., Toronto, ON M5G 0A3, Canada
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Levy DT, Cadham CJ, Li Y, Yuan Z, Liber AC, Oh H, Travis N, Issabakhsh M, Sweanor DT, Sánchez-Romero LM, Meza R, Cummings KM. A Decision-Theoretic Public Health Framework for Heated Tobacco and Nicotine Vaping Products. Int J Environ Res Public Health 2022; 19:13431. [PMID: 36294011 PMCID: PMC9602493 DOI: 10.3390/ijerph192013431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/22/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
Markets for nicotine vaping products (NVPs) and heated tobacco products (HTPs) have grown as these products became positioned as harm-reduction alternatives to combusted tobacco products. Herein, we present a public health decision-theoretic framework incorporating different patterns of HTP, NVP, and cigarette use to examine their impacts on population health. Our framework demonstrates that, for individuals who would have otherwise smoked, HTP use may provide public health benefits by enabling cessation or by discouraging smoking initiation and relapse. However, the benefits are reduced if more harmful HTP use replaces less harmful NVP use. HTP use may also negatively impact public health by encouraging smoking by otherwise non-smokers or by encouraging initiation or relapse into smoking. These patterns are directly influenced by industry behavior as well as public policy towards HTPs, NVPs, and cigarettes. While substantial research has been devoted to NVPs, much less is known about HTPs. Better information is needed to more precisely define the health risks of HTPs compared to cigarettes and NVPs, the relative appeal of HTPs to consumers, and the likelihood of later transitioning to smoking or quitting all products. While our analysis provides a framework for gaining that information, it also illustrates the complexities in distinguishing key factors.
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Affiliation(s)
- David T. Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Christopher J. Cadham
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Yameng Li
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Zhe Yuan
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Alex C. Liber
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Hayoung Oh
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Nargiz Travis
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Mona Issabakhsh
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - David T. Sweanor
- Centre for Health Law, Policy & Ethics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Faculty of Law, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | | | - Rafael Meza
- Department of Integrative Oncology, BC Cancer Institute, Vancouver, BC V5Z1L3, Canada
| | - K. Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of Charleston, Charleston, SC 29425, USA
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Sargent JD, Halenar MJ, Edwards KC, Woloshin S, Schwartz L, Emond J, Tanski S, Taylor KA, Pierce JP, Liu J, Goniewicz ML, Niaura R, Anic G, Chen Y, Callahan-Lyon P, Gardner LD, Thekkudan T, Borek N, Kimmel HL, Cummings KM, Hyland A, Brunette M. Tobacco Use and Respiratory Symptoms Among Adults: Findings From the Longitudinal Population Assessment of Tobacco and Health (PATH) Study 2014-2016. Nicotine Tob Res 2022; 24:1607-1618. [PMID: 35366322 PMCID: PMC9575972 DOI: 10.1093/ntr/ntac080] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/17/2022] [Accepted: 03/31/2022] [Indexed: 12/21/2022]
Abstract
INTRODUCTION We examined the relationship between current tobacco use and functionally important respiratory symptoms. METHODS Longitudinal cohort study of 16 295 US adults without COPD in Waves 2-3 (W2-3, 2014-2016) of the Population Assessment of Tobacco and Health Study. Exposure-Ten mutually exclusive categories of tobacco use including single product, multiple product, former, and never use (reference). Outcome-Seven questions assessing wheezing/cough were summed to create a respiratory symptom index; cutoffs of ≥2 and ≥3 were associated with functional limitations and poorer health. Multivariable regressions examined both cutoffs cross-sectionally and change over approximately 12 months, adjusting for confounders. RESULTS All tobacco use categories featuring cigarettes (>2/3's of users) were associated with higher risk (vs. never users) for functionally important respiratory symptoms at W2, for example, at symptom severity ≥ 3, risk ratio for exclusive cigarette use was 2.34 [95% CI, 1.92, 2.85] and for worsening symptoms at W3 was 2.80 [2.08, 3.76]. There was largely no increased symptom risk for exclusive use of cigars, smokeless tobacco, hookah, or e-cigarettes (adjustment for pack-years and marijuana attenuated the cross-sectional e-cigarette association from 1.53(95% CI 0.98, 2.40) to 1.05 (0.67, 1.63); RRs for these products were also significantly lower compared to exclusive use of cigarettes. The longitudinal e-cigarette-respiratory symptom association was sensitive to the respiratory index cutoff level; exclusive e-cigarette use was associated with worsening symptoms at an index cutoff ≥ 2 (RR = 1.63 [1.02, 2.59]) and with symptom improvement at an index cutoff of ≥ 3 (RR = 1.64 [1.04, 2.58]). CONCLUSIONS Past and current cigarette smoking drove functionally important respiratory symptoms, while exclusive use of other tobacco products was largely not associated. However, the relationship between e-cigarette use and symptoms was sensitive to adjustment for pack-years and symptom severity. IMPLICATIONS How noncigarette tobacco products affect respiratory symptoms is not clear; some studies implicate e-cigarettes. We examined functionally important respiratory symptoms (wheezing/nighttime cough) among US adults without COPD. The majority of adult tobacco users smoke cigarettes and have higher risk of respiratory symptoms and worsening of symptoms, regardless of other products used with them. Exclusive use of other tobacco products (e-cigarettes, cigars, smokeless, hookah) was largely not associated with functionally important respiratory symptoms and risks associated with their use was significantly lower than for cigarettes. The association for e-cigarettes was greatly attenuated by adjustment for cigarette pack-years and sensitive to how symptoms were defined.
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Affiliation(s)
- James D Sargent
- Geisel School of Medicine at Dartmouth, The C. Everett Koop Institute at Dartmouth, Lebanon, NH, USA
| | | | | | - Steven Woloshin
- Dartmouth Institute for Health Policy and Clinical Practice, The C. Everett Koop Institute at Dartmouth, The Lisa Schwartz Foundation, Lebanon, NH, USA
| | - Lisa Schwartz
- Dartmouth Institute for Health Policy and Clinical Practice, The C. Everett Koop Institute at Dartmouth, The Lisa Schwartz Foundation, Lebanon, NH, USA
| | - Jennifer Emond
- Geisel School of Medicine at Dartmouth, The C. Everett Koop Institute at Dartmouth, Lebanon, NH, USA
| | - Susanne Tanski
- Geisel School of Medicine at Dartmouth, The C. Everett Koop Institute at Dartmouth, Lebanon, NH, USA
| | | | - John P Pierce
- Moore’s Cancer Center, University of California at San Diego, San Diego, CA, USA
| | | | | | | | - Gabriella Anic
- U.S. Food and Drug Administration, Center for Tobacco Products, Bethesda, MD, USA
| | - Yanling Chen
- U.S. Food and Drug Administration, Center for Tobacco Products, Bethesda, MD, USA
| | | | - Lisa D Gardner
- U.S. Food and Drug Administration, Center for Tobacco Products, Bethesda, MD, USA
| | - Theresa Thekkudan
- U.S. Food and Drug Administration, Center for Tobacco Products, Bethesda, MD, USA
| | - Nicolette Borek
- U.S. Food and Drug Administration, Center for Tobacco Products, Bethesda, MD, USA
| | - Heather L Kimmel
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
| | | | - Andrew Hyland
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Mary Brunette
- Geisel School of Medicine at Dartmouth, The C. Everett Koop Institute at Dartmouth, Lebanon, NH, USA
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Felicione NJ, Schneller LM, Goniewicz ML, Hyland AJ, Cummings KM, Bansal-Travers M, Fong GT, O'Connor RJ. Oral Nicotine Product Awareness and Use Among People Who Smoke and Vape in the U.S. Am J Prev Med 2022; 63:611-618. [PMID: 35667923 PMCID: PMC9509436 DOI: 10.1016/j.amepre.2022.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/12/2022] [Accepted: 04/15/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Tobacco-free oral nicotine products are an emerging class of noncombustible nicotine products. Oral nicotine product sales have increased since 2016, although little research has investigated consumer awareness, use, or correlates of oral nicotine product use. The purpose of this analysis was to assess the prevalence and correlates of oral nicotine product awareness and use. METHODS This paper is a cross-sectional analysis of 2,507 U.S. participants from Wave 3 (February-June 2020) of the International Tobacco Control Four Country Smoking and Vaping Survey, a population-based survey of current and former cigarette smokers and nicotine vaping product users in the U.S. Oral nicotine product awareness and use prevalence were compared with those of heated tobacco products. Analyses conducted in late 2021 assessed the correlates of oral nicotine product awareness and use such as demographic characteristics, tobacco use (cigarettes, nicotine vaping products, smokeless tobacco), and tobacco quit attempts. RESULTS Almost 1 in 5 respondents claimed to have heard of oral nicotine products, 3.0% reported ever use, and 0.9% were current users, all of which were lower than for heated tobacco products. Ever use of oral nicotine products was more common among younger adults (e.g., aged 18-24 years), males, and current users of smokeless tobacco. Oral nicotine product prevalence was higher among those who reported having made attempts to stop smoking or vaping. CONCLUSIONS Oral nicotine product use was low among current and former smokers and nicotine vaping product users. Oral nicotine product users were demographically similar to use among individuals who smoke/vape and also use smokeless tobacco. Future studies are needed to understand emerging oral nicotine products, particularly whether they are being used as product supplements (dual use), replacements (switching), or cessation aids (quitting).
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Affiliation(s)
- Nicholas J Felicione
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York.
| | - Liane M Schneller
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Maciej L Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Andrew J Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - K Michael Cummings
- Department of Psychiatry & Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Maansi Bansal-Travers
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada; Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York
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Yong HH, Chow R, East K, Thrasher JF, Hitchman SC, Borland R, Cummings KM, Fong GT. Do Social Norms for Cigarette Smoking and Nicotine Vaping Product Use Predict Trying Nicotine Vaping Products and Attempts to Quit Cigarette Smoking Amongst Adult Smokers? Findings From the 2016-2020 International Tobacco Control Four Country Smoking and Vaping Surveys. Nicotine Tob Res 2022; 25:505-513. [PMID: 36082962 PMCID: PMC9910125 DOI: 10.1093/ntr/ntac212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/04/2022] [Accepted: 09/08/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION To examine whether perceived injunctive and descriptive social norms towards cigarette and nicotine vaping product (NVP) use predicted subsequent trying NVPs and attempts to quit cigarette smoking amongst current smokers and whether associations varied across countries. AIMS AND METHODS Three waves of longitudinal cohort data from the International Tobacco Control Four Country Smoking and Vaping Survey were collected between 2016 and 2020 from 2290 adult smokers in Canada, Australia, England, and the United States who had never used NVPs at baseline (either wave 1 or wave 2) and followed up at the subsequent wave (wave 2 or wave 3, respectively) were analyzed using Generalized Estimating Equations. RESULTS Of the injunctive and descriptive norm measures for smoking and NVP use, NVP initiation was only independently predicted by the injunctive interpersonal norm for NVP use, with perceived approval of NVP use by important others predicting higher odds of trying NVPs (AOR = 1.65, 95% CI = 1.20 to 2.27). This predictive effect was independent of baseline quit intention with no country variations found. By contrast, making cigarette smoking quit attempts were independently predicted by both injunctive and descriptive interpersonal norms with perceived disapproval of smoking by important others (AOR = 1.65, 95% CI = 1.38 to 1.99) and close friends using NVPs (AOR = 1.37, 95% CI = 1.04 to 1.79), both associated with higher odds of smoking quit attempts. CONCLUSIONS Adult smokers who perceive NVP use as normative, either because such behavior is socially approved or common within their close social networks, appear more inclined to try NVPs or make smoking quit attempts than smokers who do not. IMPLICATIONS Social norms can shape a person's behavior and result in behavior change. This study shows that initiation of NVP use behavior among smokers can be reliably predicted by their perception of whether NVP use is acceptable to those important to them within their close social networks. Similarly, any attempts to stop cigarette smoking can be predicted by their perception of how acceptable cigarette smoking is among those who are important to them and whether any of their close friends use NVPs. Changing social norms towards cigarette smoking and NVP use could therefore be incorporated into smoking cessation interventions to help smokers to quit and/or switch to NVP use.
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Affiliation(s)
- Hua-Hie Yong
- Corresponding Author: Hua Yong, PhD, 1 Gheringhap Street, Geelong, Victoria 3220, Australia. Telephone: 61-3-9244-6909; Fax: 61-3-9244-6858; E-mail:
| | - Ruth Chow
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Katherine East
- Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Sara C Hitchman
- Department of Communication and Media Research, University of Zurich, Zurich, Switzerland
| | - Ron Borland
- Melbourne Centre for Behaviour Change, School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - K Michael Cummings
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada,Ontario Institute for Cancer Research, Toronto, Ontario, Canada
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Levy DT, Gartner C, Liber AC, Sánchez-Romero LM, Yuan Z, Li Y, Cummings KM, Borland R. The Australia Smoking and Vaping Model: The Potential Impact of Increasing Access to Nicotine Vaping Products. Nicotine Tob Res 2022; 25:486-497. [PMID: 36073731 PMCID: PMC9910149 DOI: 10.1093/ntr/ntac210] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 08/08/2022] [Accepted: 09/06/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND We model the potential impact of relaxing current nicotine vaping product (NVP) restrictions on public health in Australia. AIMS AND METHODS A Restricted NVP Scenario was first developed to project current smoking and vaping rates, where a U.S. smoking model was calibrated to recent Australian trends. To model less restrictive NVP policies, a Permissive NVP Scenario applied rates of switching from smoking to vaping, initiation into NVP and cigarette use, and cessation from smoking and vaping based on U.S. trends. The model measures vaping risk relative to the excess mortality rate of smoking. The public health impacts are measured as the difference between smoking- and vaping-attributable deaths (SVADs) and life years lost (LYLs) in the Restricted and Permissive NVP Scenarios. Sensitivity analysis is conducted regarding the NVP excess risk and other factors. RESULTS Assuming an NVP excess risk of 5% that of smoking, 104.2 thousand SVADs (7.7% reduction) and 2.05 million LYLs (17.3% reduction) are averted during 2017-2080 in the Permissive NVP Scenario compared to the Restricted NVP Scenario. Assuming 40% NVP excess risk, 70 thousand SVADs and 1.2 million LYLs are averted. The impact is sensitive to the rate at which smokers switch to NVPs and quit smoking, and relatively insensitive to the smoking initiation and NVP initiation and cessation rates. CONCLUSIONS The model suggests the potential for public health gains to be achieved by relaxing NVP access regulations. However, the model would benefit from better information regarding the impact of NVPs on smoking under a relaxation of current restrictions. IMPLICATIONS Australia has implemented a strong array of cigarette-oriented policies, but has restricted access to NVPs. The Smoking and Vaping Model offers a framework for modeling hypothetical policy scenarios. The Australian model shows the potential for public health gains by maintaining cigarette-oriented policies while relaxing the current restrictive NVP policy. Modeling results under a permissive NVP policy are particularly sensitive to the estimated rates of smoking cessation and switching to vaping, which are not well established and will likely depend on past and future cigarette-oriented policies and the specific NVP policies implemented in Australia.
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Affiliation(s)
- David T Levy
- Corresponding Author: David T. Levy PhD, Georgetown University, 3300 Whitehaven St., NW, Suite 4100, Washington, DC, 20007, USA. Telephone: 301-275-2396; fax: 202-687-0305; E-mail:
| | - Coral Gartner
- School of Public Health, Faculty of Medicine, University of Queensland, Queensland, Australia
| | - Alex C Liber
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington DC, USA
| | | | - Zhe Yuan
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington DC, USA
| | - Yameng Li
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington DC, USA
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, USA
| | - Ron Borland
- Melbourne Centre for Behaviour Change, School of Psychological Sciences, University of Melbourne, Melbourne, Australia
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Gravely S, Meng G, Hammond D, Hyland A, Michael Cummings K, Borland R, Kasza KA, Yong HH, Thompson ME, Quah ACK, Ouimet J, Martin N, O'Connor RJ, East KA, McNeill A, Boudreau C, Levy DT, Sweanor DT, Fong GT. Differences in cigarette smoking quit attempts and cessation between adults who did and did not take up nicotine vaping: Findings from the ITC four country smoking and vaping surveys. Addict Behav 2022; 132:107339. [PMID: 35605409 PMCID: PMC9202449 DOI: 10.1016/j.addbeh.2022.107339] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 03/10/2022] [Accepted: 04/17/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION There is mixed evidence as to whether nicotine vaping products (NVPs) can help adults who smoke transition away from cigarettes. This study investigated if self-reported attempts to quit smoking and smoking cessation, over a period of either 18 or 24 months, differed between respondents who initiated nicotine vaping versus those who did not. Outcome comparisons were made between those who: (1) initiated vaping vs. those who did not; (2) initiated daily or non-daily vaping vs. those who did not; and (3) initiated daily or non-daily vaping between surveys and continued to vape at follow-up (daily or non-daily) vs. those who did not initiate vaping. METHODS This cohort study included 3516 respondents from the ITC Four Country Smoking and Vaping Surveys (Australia, Canada, England, United Sates), recruited at Wave 1 (2016) or 2 (2018) and followed up at Wave 2 (18 months) and/or 3 (2020, 24 months). Adults who smoked daily at baseline and did not have a history of regular vaping were included. Initiation of vaping was defined as beginning to vape at least monthly between surveys. Respondents indicated whether they made an attempt to quit smoking between surveys. Smoking cessation was defined as those who self-reported no longer smoking cigarettes at follow-up. RESULTS Relative to those who did not initiate vaping, initiation of any daily vaping between surveys was associated with a greater likelihood of smokers making a cigarette quit attempt (p < 0.001) and quitting smoking (p < 0.001). Among smokers who attempted to quit smoking, initiation of daily vaping was associated with a greater likelihood of being abstinent from smoking at follow-up (p = 0.001). Respondents who initiated vaping between surveys and were vaping daily at follow up were significantly more likely to have attempted to quit smoking (p < 0.001) and to have quit smoking (p < 0.001) than those who did not initiate vaping. Respondents who initiated non-daily vaping did not differ significantly from those who did not initiate vaping on any of the outcome measures. CONCLUSIONS Daily NVP use was associated with increased attempts to quit smoking and abstinence from smoking cigarettes. These findings are consistent with the concept that complete cigarette substitution may be more likely to be achieved when smokers vape nicotine daily.
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Affiliation(s)
| | - Gang Meng
- Department of Psychology, University of Waterloo, Canada
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Canada
| | - Andrew Hyland
- Department of Health Behavior, Division of Cancer Prevention & Population Sciences, Roswell Park Comprehensive Cancer Center, USA
| | - K Michael Cummings
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, USA
| | - Ron Borland
- Melbourne Centre for Behaviour Change, School of Psychological Sciences, University of Melbourne, Australia
| | - Karin A Kasza
- Department of Health Behavior, Division of Cancer Prevention & Population Sciences, Roswell Park Comprehensive Cancer Center, USA
| | - Hua-Hie Yong
- School of Psychology, Deakin University, Australia
| | - Mary E Thompson
- Department of Statistics and Actuarial Science, University of Waterloo, Canada
| | - Anne C K Quah
- Department of Psychology, University of Waterloo, Canada
| | - Janine Ouimet
- Department of Psychology, University of Waterloo, Canada
| | - Nadia Martin
- Department of Psychology, University of Waterloo, Canada
| | - Richard J O'Connor
- Department of Health Behavior, Division of Cancer Prevention & Population Sciences, Roswell Park Comprehensive Cancer Center, USA
| | - Katherine A East
- School of Public Health Sciences, University of Waterloo, Canada; Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King's College London, England
| | - Ann McNeill
- Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King's College London, England; Shaping Public Health Policies to Reduce Inequalities & Harm (SPECTRUM), UK
| | - Christian Boudreau
- Department of Statistics and Actuarial Science, University of Waterloo, Canada
| | - David T Levy
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, USA
| | | | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Canada; School of Public Health Sciences, University of Waterloo, Canada; Ontario Institute for Cancer Research, Canada
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